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General NPI Number Information
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NPI Number | 1639640782
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Entity Type | Individual
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Provider Name | CORT DARCY THOMPSON PA
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Gender | Male
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 921 OAK PARK BLVD STE 202
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City | PISMO BEACH
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State | CA
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Zip | 93449-3400
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Country | US
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Telephone | 805-473-7818
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Fax | 805-473-7820
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Provider Business Mailing Address
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Address Line | PO BOX 2553
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City | PASO ROBLES
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State | CA
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Zip | 93447-2553
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Country | US
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Telephone | 805-674-7411
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA56325
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License Number State | CA
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