Healthcare Provider Details

I. General information

NPI: 1770875635
Provider Name (Legal Business Name): KIM CARLOTTA THOMAS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WILLOW PASS RD SUITE 200
CONCORD CA
94520-5223
US

IV. Provider business mailing address

1420 WILLOW PASS RD SUITE 200
CONCORD CA
94520-5223
US

V. Phone/Fax

Practice location:
  • Phone: 925-646-5480
  • Fax: 925-646-5622
Mailing address:
  • Phone: 925-646-5480
  • Fax: 925-646-5622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number752784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: