Individual
OCTAVIO ANDRES TOBAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1950 BARRETT LAKES BLVD NW APT 1213, KENNESAW, GA 30144
(813) 447-0124
Mailing address
1950 BARRETT LAKES BLVD NW APT 1213, KENNESAW, GA 30144-7535
(813) 447-0124
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AL4196
FL
2255A2300X
Athletic Trainer
Primary
AT003335
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL4196
FLORIDA DEPARTMENT OF HEALTH
FL
01
—
AT003335
SECRETARY OF STATE
GA
Enumeration date
07/19/2017
Last updated
08/20/2018
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