Healthcare Provider Details

I. General information

NPI: 1184767360
Provider Name (Legal Business Name): ANDREW THIO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41670 IVY ST SUITE B
MURRIETA CA
92562-9432
US

IV. Provider business mailing address

41670 IVY ST SUITE B
MURRIETA CA
92562-9432
US

V. Phone/Fax

Practice location:
  • Phone: 951-600-7702
  • Fax: 951-600-5987
Mailing address:
  • Phone: 951-600-7702
  • Fax: 951-600-5987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG75296
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW HOK-SAN THIO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-600-7702