MEDICARE: DR. AMY THERESA THOMAS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	20A9564	CA

General Provider Information

NPI Number	:	1447481924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY THERESA THOMAS D.O.

Provider Business Mailing Address
First Line	:	4421 RUTGERS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1428
Country	:	US
Telephone Number	:	951-805-8314
Fax Number	:

Provider Business Practice Location Address
First Line	:	4421 RUTGERS AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1428
Country	:	US
Telephone Number	:	951-805-8314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2009
Last Update Date	:	08/02/2009

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