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General NPI Number Information
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NPI Number | 1992966105
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Entity Type | Individual
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Provider Name | THOMAS DAVID WALBOLT D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 400 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone | 909-580-6222
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Fax | 909-580-1363
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Provider Business Mailing Address
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Address Line | 7828 DAY CREEK BLVD #1337
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8569
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Country | US
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Telephone | 707-344-1735
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Fax | 909-580-1363
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 20A10110
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License Number State | CA
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