Healthcare Provider Details

I. General information

NPI: 1912299124
Provider Name (Legal Business Name): LEVON JAMES THOMAS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 DAY ST
RIVERSIDE CA
92507-0901
US

IV. Provider business mailing address

6405 DAY ST
RIVERSIDE CA
92507-0901
US

V. Phone/Fax

Practice location:
  • Phone: 951-697-5611
  • Fax: 951-697-5565
Mailing address:
  • Phone: 951-697-5611
  • Fax: 951-697-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50004142
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: