Healthcare Provider Details

I. General information

NPI: 1497270748
Provider Name (Legal Business Name): TONIA M ABLOOGALOOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 A ST
ANTIOCH CA
94509-2331
US

IV. Provider business mailing address

1613 CAVALLO RD APT A
ANTIOCH CA
94509-1936
US

V. Phone/Fax

Practice location:
  • Phone: 925-978-2873
  • Fax: 925-757-0411
Mailing address:
  • Phone: 928-225-6547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: