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NPI Code Detail

MEDICARE: TRACY HELEN HYDORN PA-C

MEDICARE: TRACY HELEN HYDORN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA 13055CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1970008050OTHERCARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134118573
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY HELEN HYDORN PA-C
Provider Business Mailing Address
First Line : PO BOX 2393
Second Line :
City : CARMEL
State : CA
Zip : 93921-2393
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 9TH ST
Second Line :
City : MARINA
State : CA
Zip : 93933-6039
Country : US
Telephone Number : 831-884-1172
Fax Number : 831-884-1033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 12/03/2019

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Directions to “ TRACY HELEN HYDORN PA-C” Practice Location

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