1568010676 NPI number — KATIE L MCINTYRE-DYKES

Table of content: KATIE L MCINTYRE-DYKES (NPI 1568010676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568010676 NPI number — KATIE L MCINTYRE-DYKES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCINTYRE-DYKES
Provider First Name:
KATIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1568010676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1730 HORSE SHOE LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRACY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95376-4377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-740-0544
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 THE ALAMEDA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95126-1136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-261-7777
Provider Business Practice Location Address Fax Number:
408-259-2273
Provider Enumeration Date:
09/01/2019

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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