1427033646 NPI number — RONALD W THOMPSON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427033646 NPI number — RONALD W THOMPSON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

THOMPSON

Provider First Name:

RONALD

Provider Middle Name:

W

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1427033646

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/16/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 512185

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:

90051-0185

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

626-775-3514

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2121 SANTA MONICA BLVD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SANTA MONICA

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

90404-2303

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

310-829-8913

Provider Business Practice Location Address Fax Number:

310-315-6168

Provider Enumeration Date:

12/09/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0001X , with the licence number:  G12376 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: WG12376K . This is a "MEDICARE EL CEN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 00G123760 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: 00G123761 . This is a "MEDICARE TEM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: WG12376F . This is a "MEDICARE SJHC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: WG12376I . This is a "MEDICARE LCM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: WG12376J . This is a "MEDICARE SAN PEDRO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: WG12376C . This is a "MEDICARE VROC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 00G123762 . This is a "MEDICARE SBMC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: G12376 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: WG12376G . This is a "MEDICARE - SJMC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
• Identifier: 00G123761 . This is a "MEDICARE RIV" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".