Healthcare Provider Details

I. General information

NPI: 1922877984
Provider Name (Legal Business Name): GOVINDA THOMAS-CARTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 01/01/2024
Certification Date: 12/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 CORMORANT DR
FAIRFIELD CA
94533-2541
US

IV. Provider business mailing address

2208 CORMORANT DR
FAIRFIELD CA
94533-2541
US

V. Phone/Fax

Practice location:
  • Phone: 916-410-8797
  • Fax:
Mailing address:
  • Phone: 916-410-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: