Healthcare Provider Details

I. General information

NPI: 1922038595
Provider Name (Legal Business Name): THOMAS TERENCE EASTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8263 GROVE AVE STE 204
RANCHO CUCAMONGA CA
91730-3107
US

IV. Provider business mailing address

8263 GROVE AVE STE 204
RANCHO CUCAMONGA CA
91730-3107
US

V. Phone/Fax

Practice location:
  • Phone: 909-931-1033
  • Fax: 909-981-8976
Mailing address:
  • Phone: 909-931-1033
  • Fax: 909-981-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA41400
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA41400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: