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General NPI Number Information
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NPI Number | 1134524663
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Entity Type | Organization
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Legal Business Name | SEAN R THOMAS M D INC
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 11 MAREBLU STE 210
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3044
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Country | US
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Telephone | 949-831-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MAREBLU STE 210
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3044
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Country | US
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Telephone | 949-831-1001
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SEAN R THOMAS
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Credential | M.D.
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Telephone | 760-364-5149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A60305
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License Number State | CA
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