Healthcare Provider Details

I. General information

NPI: 1679967996
Provider Name (Legal Business Name): EMILY HERRON THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE GENEARL MEDICINE CLINIC - SAN FRANCISCO GENERAL HOSPITA
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

611 MAPLE AVE
LOS ANGELES CA
90014-2211
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8494
  • Fax: 415-206-3012
Mailing address:
  • Phone: 213-833-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number800112408
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA147118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: