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General NPI Number Information
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NPI Number | 1053810598
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Entity Type | Individual
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Provider Name | TAMARA THOMAS
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Gender | Female
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Dates
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Enumeration Date | 02/11/2018
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Last Update Date | 03/16/2024
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Provider Practice Location Address
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Address Line | 16767 BERNARDO CENTER DR STE L1 #27384
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City | SAN DIEGO
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State | CA
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Zip | 92128-9212
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Country | US
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Telephone | 858-848-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 15525 POMERADO RD STE E4
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City | POWAY
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State | CA
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Zip | 92064-2427
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Country | US
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Telephone | 858-848-9660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 25037
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25037
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License Number State | CA
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