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

NPI 1578059069

Individual provider · NPI 1578059069 Deactivated

This NPI was deactivated on September 22, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1578059069 is listed in the national NPI registry.

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Record details

NPI number1578059069
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—