1609858000 NPI number — MRS. JENNIFER NOVAK HAWKINS PT

Table of content: MRS. JENNIFER NOVAK HAWKINS PT (NPI 1609858000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609858000 NPI number — MRS. JENNIFER NOVAK HAWKINS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWKINS
Provider First Name:
JENNIFER
Provider Middle Name:
NOVAK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOVAK
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609858000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3809 PLAZA DR
Provider Second Line Business Mailing Address:
112
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92056-4625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-941-2630
Provider Business Mailing Address Fax Number:
760-941-4617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3809 PLAZA DR
Provider Second Line Business Practice Location Address:
112
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-941-2630
Provider Business Practice Location Address Fax Number:
760-941-4617
Provider Enumeration Date:
11/19/2005

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: 225100000X , with the licence number:  39442 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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