Provider Demographics
NPI:1366512071
Name:HAWKINS, MYRT J (DO)
Entity type:Individual
Prefix:
First Name:MYRT
Middle Name:J
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Practice Address - Country:US
Practice Address - Phone:831-771-0244
Practice Address - Fax:831-771-0244
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX58271Medicaid
P00227567OtherRR MCARE
F15959Medicare UPIN
ZZZ26017ZMedicare ID - Type Unspecified
CA00AX58271Medicaid