1811942204 NPI number — ALICIA ANDREA TOBIN-WILLIAMS MD

Table of content: ALICIA ANDREA TOBIN-WILLIAMS MD (NPI 1811942204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811942204 NPI number — ALICIA ANDREA TOBIN-WILLIAMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOBIN-WILLIAMS
Provider First Name:
ALICIA
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOBIN
Provider Other First Name:
ALICIA
Provider Other Middle Name:
ANDREA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811942204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45680
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94145-0680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-672-7060
Provider Business Mailing Address Fax Number:
530-672-7061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 PALMER DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
CAMERON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95682-8276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-672-7040
Provider Business Practice Location Address Fax Number:
530-672-7061
Provider Enumeration Date:
05/23/2006

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: 207V00000X , with the licence number:  A92932 , 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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