Provider Demographics
NPI:1457510851
Name:BICKERTON, TORI ANN (NAVY IDC)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:ANN
Last Name:BICKERTON
Suffix:
Gender:F
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:ANN
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NAVY IDC
Mailing Address - Street 1:BRANCH HEALTH CLINIC NAVAL AIR FACILITY
Mailing Address - Street 2:BLDG 523
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-5015
Mailing Address - Country:US
Mailing Address - Phone:760-339-2674
Mailing Address - Fax:760-339-2661
Practice Address - Street 1:BRANCH HEALTH CLINIC NAVAL AIR FACILITY
Practice Address - Street 2:BLDG 523
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-5015
Practice Address - Country:US
Practice Address - Phone:760-339-2674
Practice Address - Fax:760-339-2661
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman