Provider Demographics
NPI:1730299058
Name:TOBIN, SYLVIA M (M A)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:M
Last Name:TOBIN
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1852
Mailing Address - Country:US
Mailing Address - Phone:505-889-9100
Mailing Address - Fax:505-888-0363
Practice Address - Street 1:3301 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1852
Practice Address - Country:US
Practice Address - Phone:505-889-9100
Practice Address - Fax:505-888-0363
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMT9008Medicaid