1750517611 NPI number — NATHAN TOKUDA

Table of content: NATHAN TOKUDA (NPI 1750517611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750517611 NPI number — NATHAN TOKUDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOKUDA
Provider First Name:
NATHAN
Provider Middle Name:
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:
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:
1750517611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MSC08 4640
Provider Second Line Business Mailing Address:
BMSB ROOM 335, 1 UNIVERSITY OF NEW MEXICO
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87131-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-4814
Provider Business Mailing Address Fax Number:
505-272-8084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 CAMINO DE SALUD
Provider Second Line Business Practice Location Address:
BMSB 335
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87131-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-4814
Provider Business Practice Location Address Fax Number:
505-272-8084
Provider Enumeration Date:
06/05/2009

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: 207ZP0102X , with the licence number:  MD2017-0492 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com