Healthcare Provider Details

I. General information

NPI: 1982108973
Provider Name (Legal Business Name): RICKY J THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

181 E SANTA CLARA ST # E1115
SAN JOSE CA
95113-1904
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-1000
  • Fax: 916-734-7950
Mailing address:
  • Phone: 415-535-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA164361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: