Provider Demographics
NPI:1730339763
Name:HERNANDEZ, TOBY NATIVIDAD (IDC)
Entity type:Individual
Prefix:
First Name:TOBY
Middle Name:NATIVIDAD
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MAUSER COURT
Mailing Address - Street 2:
Mailing Address - City:COLEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96107
Mailing Address - Country:US
Mailing Address - Phone:760-932-1611
Mailing Address - Fax:
Practice Address - Street 1:MWTC BLDG 3005 STATE ROUTE 108
Practice Address - Street 2:ATTN: MEDICAL
Practice Address - City:BRIDGEPORT
Practice Address - State:CA
Practice Address - Zip Code:93517
Practice Address - Country:US
Practice Address - Phone:760-932-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman