Basic Information
| Provider Information | |||||||||
| NPI: | 1417170044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOTH | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 BAYVIEW DRIVE | ||||||||
| Address2: | |||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945016344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105217398 | ||||||||
| FaxNumber: | 5105680225 | ||||||||
| Practice Location | |||||||||
| Address1: | 24100 AMADOR | ||||||||
| Address2: | SUITE 250 WINTON WELLNESS CENTER | ||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102661700 | ||||||||
| FaxNumber: | 5102661762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G9054 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | G9054 | 05 | CA | MEDICAID |