Healthcare Provider Details

I. General information

NPI: 1073334033
Provider Name (Legal Business Name): ELLA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIA THOMAS

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S BASCOM AVE
SAN JOSE CA
95128-2601
US

IV. Provider business mailing address

1922 THE ALAMEDA
SAN JOSE CA
95126-1457
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax: 408-642-6052
Mailing address:
  • Phone: 408-261-7777
  • Fax: 408-642-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: