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

NPI 1790698082

Individual provider · NPI 1790698082 Deactivated

This NPI was deactivated on October 3, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1790698082 is listed in the national NPI registry.

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Record details

NPI number1790698082
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—