Healthcare Provider Details

I. General information

NPI: 1346288321
Provider Name (Legal Business Name): THOMAS L ATLAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13422 NEWPORT AVE SUITE I
TUSTIN CA
92780-3746
US

IV. Provider business mailing address

13422 NEWPORT AVE SUITE I
TUSTIN CA
92780-3746
US

V. Phone/Fax

Practice location:
  • Phone: 714-665-6900
  • Fax: 714-665-6904
Mailing address:
  • Phone: 714-665-6900
  • Fax: 714-665-6904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberG74535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: