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General NPI Number Information
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NPI Number | 1669655536
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Entity Type | Organization
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Legal Business Name | WALTER ALAIN THOMAS, M.D.
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 3444 KEARNY VILLA RD SUITE#3
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City | SAN DIEGO
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State | CA
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Zip | 92123-1959
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Country | US
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Telephone | 858-616-6400
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Fax | 858-616-6936
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Provider Business Mailing Address
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Address Line | 3444 KEARNY VILLA RD SUITE#303
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City | SAN DIEGO
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State | CA
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Zip | 92123-1959
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Country | US
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Telephone | 858-616-6400
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Fax | 858-616-6936
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MS. ISABEL GARCIA
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Credential | ETC.
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Telephone | 858-616-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | A67913
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License Number State | CA
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