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

NPI 1871763219

Individual provider · NPI 1871763219 Deactivated

This NPI was deactivated on September 24, 2026. The record is kept for reference and should not be used for billing or referrals.

NPI 1871763219 is listed in the national NPI registry.

Practice location Incomplete address

The federal record is missing the street or ZIP for this provider.

Specialties & licences

Record details

NPI number1871763219
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—