Healthcare Provider Details

I. General information

NPI: 1154153633
Provider Name (Legal Business Name): AMANDA D THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 17TH ST
OAKLAND CA
94612-4124
US

IV. Provider business mailing address

27585 E TRAIL RIDGE WAY APT 2070
MORENO VALLEY CA
92555-3108
US

V. Phone/Fax

Practice location:
  • Phone: 510-238-5020
  • Fax: 510-352-9981
Mailing address:
  • Phone: 760-382-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: