1528268802 NPI number — DR. NATASHA GEORGINA THOMAS M.D.

Table of content: DR. NATASHA GEORGINA THOMAS M.D. (NPI 1528268802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528268802 NPI number — DR. NATASHA GEORGINA THOMAS M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRIFUNOVIC
Provider Other First Name:
NATASHA
Provider Other Middle Name:
GEORGINA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528268802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19400 BEACH BLVD
Provider Second Line Business Mailing Address:
UNIT 11
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92648-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-968-1222
Provider Business Mailing Address Fax Number:
714-968-1777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19400 BEACH BLVD
Provider Second Line Business Practice Location Address:
UNIT 11
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92648-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-968-1222
Provider Business Practice Location Address Fax Number:
714-968-1777
Provider Enumeration Date:
07/24/2007

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: 207Q00000X , with the licence number:  642-L , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: A115473 , 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)

  • Identifier: CB212834 . This is a "MEDICARE ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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