Healthcare Provider Details

I. General information

NPI: 1033035076
Provider Name (Legal Business Name): MR. GEORGE RAY THOMAS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44230 ARTESIA MILL CT
LANCASTER CA
93535-6254
US

IV. Provider business mailing address

10910 LONG BEACH BLVD STE 103 PMB 607
LYNWOOD CA
90262-2687
US

V. Phone/Fax

Practice location:
  • Phone: 760-474-0330
  • Fax:
Mailing address:
  • Phone: 760-474-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: