Healthcare Provider Details

I. General information

NPI: 1033225636
Provider Name (Legal Business Name): ANGELYN R THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MILVIA ST
BERKELEY CA
94704
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-5600
  • Fax: 510-204-5462
Mailing address:
  • Phone: 510-204-5600
  • Fax: 510-204-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG85229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: