Healthcare Provider Details

I. General information

NPI: 1154231488
Provider Name (Legal Business Name): DOUGLAS S THOMAS JR. CCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W ROSAMOND BLVD
ROSAMOND CA
93560-6434
US

IV. Provider business mailing address

22560 WESTWOOD BLVD
TEHACHAPI CA
93561-8217
US

V. Phone/Fax

Practice location:
  • Phone: 661-256-5000
  • Fax:
Mailing address:
  • Phone: 775-813-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number42186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: