Provider Demographics
NPI:1053354340
Name:HYLAND, THOMAS O (DPM PODIATRIST)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:O
Last Name:HYLAND
Suffix:
Gender:M
Credentials:DPM PODIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CAPITOLA AVENUE
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2759
Mailing Address - Country:US
Mailing Address - Phone:831-465-8213
Mailing Address - Fax:831-465-8215
Practice Address - Street 1:525 CAPITOLA AVENUE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2759
Practice Address - Country:US
Practice Address - Phone:831-465-8213
Practice Address - Fax:831-465-8215
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2303213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000E23030Medicare ID - Type Unspecified
T11271Medicare UPIN