Provider Demographics
NPI:1740235639
Name:TOYAMA, MACK DAVID (DC, PA-C)
Entity type:Individual
Prefix:DR
First Name:MACK
Middle Name:DAVID
Last Name:TOYAMA
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 HOLSER WALK
Mailing Address - Street 2:#315
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2633
Mailing Address - Country:US
Mailing Address - Phone:805-988-2273
Mailing Address - Fax:805-981-8281
Practice Address - Street 1:1901 HOLSER WALK
Practice Address - Street 2:#315
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2633
Practice Address - Country:US
Practice Address - Phone:805-988-2273
Practice Address - Fax:805-981-8281
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22187111N00000X
CARHC137145247200000X
CAPA17044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0221870Medicaid
CADC22187AMedicare ID - Type UnspecifiedMEDICARE PROVIDER
CADC0221870Medicaid