Provider Demographics
NPI:1255528782
Name:MYRT HAWKINS, DO
Entity type:Organization
Organization Name:MYRT HAWKINS, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-630-1302
Mailing Address - Street 1:PO BOX 2495
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93902-2495
Mailing Address - Country:US
Mailing Address - Phone:831-771-0244
Mailing Address - Fax:831-771-0243
Practice Address - Street 1:31 WINHAM ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3314
Practice Address - Country:US
Practice Address - Phone:831-771-0244
Practice Address - Fax:831-771-0243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX58271Medicaid
CAZZZ26017ZMedicare PIN
CA00AX58271Medicaid