Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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NPI 1063435501

Individual provider · NPI 1063435501 Deactivated

This NPI was deactivated on October 1, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1063435501 is listed in the national NPI registry.

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Record details

NPI number1063435501
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—