1760707442 NPI number — TODD CONAN TROWBRIDGE

Table of content: TODD CONAN TROWBRIDGE (NPI 1760707442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760707442 NPI number — TODD CONAN TROWBRIDGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROWBRIDGE
Provider First Name:
TODD
Provider Middle Name:
CONAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TROWBRIDGE
Provider Other First Name:
TODD
Provider Other Middle Name:
CONAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760707442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 CASTLEFORD CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-487-6397
Provider Business Mailing Address Fax Number:
925-855-1902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 CASTLEFORD CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94526-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-487-6397
Provider Business Practice Location Address Fax Number:
925-855-1902
Provider Enumeration Date:
04/06/2010

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: 225XP0200X , with the licence number:  OT 1825 , 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)