Healthcare Provider Details

I. General information

NPI: 1447467899
Provider Name (Legal Business Name): CECILIA THOMPSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-3129
US

IV. Provider business mailing address

4145 10TH AVE
SAN DIEGO CA
92103-2302
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8153
  • Fax:
Mailing address:
  • Phone: 463-205-6406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50247
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247028
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number50247
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number247028
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number143037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: