Provider Demographics
NPI:1952446783
Name:TOLBERT, TRAVIS LAFAYETTE
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LAFAYETTE
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5314 COAST GUARD 2100 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:510-437-3456
Mailing Address - Fax:
Practice Address - Street 1:1 EAGLE RD
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5100
Practice Address - Country:US
Practice Address - Phone:510-437-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other