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General NPI Number Information
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NPI Number | 1881058592
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Entity Type | Individual
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Provider Name | TERRON THOMAS
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Gender | Male
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 445 SOUTH G, UNIT B
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City | SAN BERNARDINO
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State | IN
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Zip | 92410
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Country | US
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Telephone | 909-770-0858
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Fax | 909-335-8189
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Provider Business Mailing Address
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Address Line | 1139 ALEXIS LANE
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City | REDLANDS
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State | CA
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Zip | 92374
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Country | US
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Telephone | 909-770-0858
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Fax | 909-335-8189
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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 | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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