Healthcare Provider Details

I. General information

NPI: 1154557965
Provider Name (Legal Business Name): MARK TOMPKINS BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W. TUNNEL ST.
SANTA MARIA CA
93454
US

IV. Provider business mailing address

912 E ORANGE ST
SANTA MARIA CA
93454-5843
US

V. Phone/Fax

Practice location:
  • Phone: 805-614-4940
  • Fax: 805-614-0179
Mailing address:
  • Phone: 805-268-2482
  • Fax: 805-614-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: