Healthcare Provider Details

I. General information

NPI: 1629250303
Provider Name (Legal Business Name): SHERRY THOMAS A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29525 CANWOOD ST SUITE 211
AGOURA HILLS CA
91301-4233
US

IV. Provider business mailing address

PO BOX 1251
AGOURA HILLS CA
91376-1251
US

V. Phone/Fax

Practice location:
  • Phone: 818-991-0988
  • Fax: 818-991-0918
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberC42670
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberC42670
License Number StateCA

VIII. Authorized Official

Name: SHERRY THOMAS
Title or Position: CEO
Credential:
Phone: 818-766-9881