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

NPI 1720715758

Individual provider · NPI 1720715758 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 1720715758 is listed in the national NPI registry.

Claim this listing Report a problem Suggest an edit

Practice location Incomplete address

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

No coordinates on file. Search this address in Google Maps

Specialties & licences

Record details

NPI number1720715758
Entity typeIndividual (Type 1)
NPI enumerated—
Last updated in NPPES—