Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 95002076 | CA |
NPI | 1013366053 |
---|---|
Provider Name | Tina Thomas |
First Address | Irvine, CA 92612-2447 |
Second Address | Irvine, CA 92612-2447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2016 |
Last Update Date | 10/06/2016 |