1528315587 NPI number — MS. CHRISTINE DINIO GRAJO TOMBERG M.A.

Table of content: MS. CHRISTINE DINIO GRAJO TOMBERG M.A. (NPI 1528315587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528315587 NPI number — MS. CHRISTINE DINIO GRAJO TOMBERG M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOMBERG
Provider First Name:
CHRISTINE
Provider Middle Name:
DINIO GRAJO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

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:
1528315587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 ELM ST STE 212
Provider Second Line Business Mailing Address:
STARVISTA
Provider Business Mailing Address City Name:
SAN CARLOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94070-3070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
650-591-9750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 ELM ST STE 212
Provider Second Line Business Practice Location Address:
STARVISTA
Provider Business Practice Location Address City Name:
SAN CARLOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94070-3070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-591-9623
Provider Business Practice Location Address Fax Number:
650-591-9750
Provider Enumeration Date:
08/09/2012

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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