Healthcare Provider Details

I. General information

NPI: 1770456592
Provider Name (Legal Business Name): MR. JOSEPH CHARLES THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 42ND ST APT A
SACRAMENTO CA
95820-2859
US

IV. Provider business mailing address

4002 42ND ST APT A
SACRAMENTO CA
95820-2859
US

V. Phone/Fax

Practice location:
  • Phone: 916-539-9860
  • Fax:
Mailing address:
  • Phone: 916-539-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: