Healthcare Provider Details

I. General information

NPI: 1831719145
Provider Name (Legal Business Name): CHRIS THORNTON RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

111 FITHIAN WAY
FOLSOM CA
95630-1965
US

V. Phone/Fax

Practice location:
  • Phone: 530-218-5304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number32678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: