1730339763 NPI number — TOBY NATIVIDAD HERNANDEZ IDC

Table of content: TOBY NATIVIDAD HERNANDEZ IDC (NPI 1730339763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730339763 NPI number — TOBY NATIVIDAD HERNANDEZ IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
TOBY
Provider Middle Name:
NATIVIDAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730339763
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 MAUSER COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-932-1611
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MWTC BLDG 3005 STATE ROUTE 108
Provider Second Line Business Practice Location Address:
ATTN: MEDICAL
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-932-1616
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)