Provider Demographics
NPI:1346202850
Name:TOLIVER, KEVIN TODD (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TODD
Last Name:TOLIVER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4060 4TH AVE
Mailing Address - Street 2:STE 700
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2121
Mailing Address - Country:US
Mailing Address - Phone:619-299-8500
Mailing Address - Fax:619-297-1443
Practice Address - Street 1:4060 4TH AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:619-299-8500
Practice Address - Fax:619-297-1443
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2017-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG76523207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG76523BMedicare PIN