Healthcare Provider Details

I. General information

NPI: 1578537494
Provider Name (Legal Business Name): THOMAS EDWARD DEBLOIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 PARK BLVD., STE. #214
SAN DIEGO CA
92116-4049
US

IV. Provider business mailing address

PO BOX 9452
SAN DIEGO CA
92169-0452
US

V. Phone/Fax

Practice location:
  • Phone: 858-427-0504
  • Fax:
Mailing address:
  • Phone: 858-427-0504
  • Fax: 541-265-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number8212
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG73409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: