Healthcare Provider Details

I. General information

NPI: 1801467543
Provider Name (Legal Business Name): ANDREW THOMAS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26732 CROWN VALLEY PKWY STE 317
MISSION VIEJO CA
92691-6374
US

IV. Provider business mailing address

4150 CHICAGO AVE UNIT 5156
RIVERSIDE CA
92517-7008
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-3322
  • Fax:
Mailing address:
  • Phone: 949-364-2525
  • Fax: 909-295-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: