Healthcare Provider Details

I. General information

NPI: 1780980227
Provider Name (Legal Business Name): LINDSAY RAE THOMAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 WEST STEWART DRIVE SUITE 508
ORANGE CA
92868-3856
US

IV. Provider business mailing address

20255 ESTUARY LANE
NEWPORT BEACH CA
92660-5606
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-2111
  • Fax: 714-633-5615
Mailing address:
  • Phone: 949-584-8503
  • Fax: 714-633-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: