Healthcare Provider Details

I. General information

NPI: 1134670466
Provider Name (Legal Business Name): CINDY HODGES DPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 SKYMASTER CIR BLDG 650
TRAVIS AFB CA
94535-1909
US

IV. Provider business mailing address

101 BODIN CIR FL 2
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7658
  • Fax: 707-423-5346
Mailing address:
  • Phone: 707-423-7657
  • Fax: 707-423-5346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9882
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5736
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: