1417017377 NPI number — DR. NATHANIEL THOMAS PH.D

Table of content: DR. NATHANIEL THOMAS PH.D (NPI 1417017377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417017377 NPI number — DR. NATHANIEL THOMAS PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
NATHANIEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417017377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1303 S RIMPAU BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90019-3022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-971-1405
Provider Business Mailing Address Fax Number:
213-487-9658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9696 CULVER BLVD STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULVER CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90232-2759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-971-1405
Provider Business Practice Location Address Fax Number:
213-487-9658
Provider Enumeration Date:
12/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY17585 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)