Provider Demographics
NPI:1053022715
Name:EBBINGS, TROY
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:
Last Name:EBBINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 BOXWOOD ST N
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-6626
Mailing Address - Country:US
Mailing Address - Phone:815-721-4045
Mailing Address - Fax:
Practice Address - Street 1:324 BOXWOOD ST N
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-6626
Practice Address - Country:US
Practice Address - Phone:815-721-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program