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General NPI Number Information
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NPI Number | 1629250303
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Entity Type | Organization
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Legal Business Name | SHERRY THOMAS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 29525 CANWOOD ST SUITE 211
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4233
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Country | US
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Telephone | 818-991-0988
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Fax | 818-991-0918
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Provider Business Mailing Address
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Address Line | PO BOX 1251
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City | AGOURA HILLS
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State | CA
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Zip | 91376-1251
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHERRY THOMAS
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Credential |
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Telephone | 818-766-9881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | C42670
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | C42670
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License Number State | CA
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