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

NPI 1790885150

Individual provider · NPI 1790885150 Deactivated

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

NPI 1790885150 is listed in the national NPI registry.

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Record details

NPI number1790885150
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—