Healthcare Provider Details

I. General information

NPI: 1598953358
Provider Name (Legal Business Name): WALTER THOMAS MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 SEQUOIA AVE
SIMI VALLEY CA
93063-3167
US

IV. Provider business mailing address

PO BOX 2218
SIMI VALLEY CA
93062-2218
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-1804
  • Fax: 805-527-5241
Mailing address:
  • Phone: 805-527-1804
  • Fax: 805-527-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA34536
License Number StateCA

VIII. Authorized Official

Name: DR. WALTER THOMAS
Title or Position: M.D.
Credential:
Phone: 805-527-1804