Healthcare Provider Details

I. General information

NPI: 1326584095
Provider Name (Legal Business Name): STEPHEN PAUL THOMAS II NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 06/20/2023
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31537 RANCHO PUEBLO RD #201
TEMECULA CA
92592-4857
US

IV. Provider business mailing address

3660 PARK SIERRA DR STE 203
RIVERSIDE CA
92505-3071
US

V. Phone/Fax

Practice location:
  • Phone: 951-687-7140
  • Fax: 951-303-3565
Mailing address:
  • Phone: 951-687-3400
  • Fax: 951-687-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95005872
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: