Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY6844 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY6844 | CA |
NPI | 1013088129 |
---|---|
Provider Name | Dr. Gaines A Thomas |
First Address | Fresno, CA 93710-7514 |
Second Address | Fresno, CA 93710-7514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2006 |
Last Update Date | 23/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S99878 | (02) | CA |