Provider Demographics
NPI:1154557965
Name:TOMPKINS, MARK (BA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:TOMPKINS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 E ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5843
Mailing Address - Country:US
Mailing Address - Phone:805-268-2482
Mailing Address - Fax:805-614-0179
Practice Address - Street 1:117 W. TUNNEL ST.
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-614-4940
Practice Address - Fax:805-614-0179
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator