Healthcare Provider Details

I. General information

NPI: 1881289379
Provider Name (Legal Business Name): CATHERINE NICOLE THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 08/15/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 3005 SR 108
BRIDGEPORT CA
93517
US

IV. Provider business mailing address

BLDG 3005 SR 108
BRIDGEPORT CA
93517
US

V. Phone/Fax

Practice location:
  • Phone: 760-932-1616
  • Fax: 760-932-1623
Mailing address:
  • Phone: 760-932-1616
  • Fax: 760-932-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101276007
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: