MEDICARE: SEAN R THOMAS M D INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A60305	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134524663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEAN R THOMAS M D INC

Provider Business Mailing Address
First Line	:	11 MAREBLU STE 210
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3044
Country	:	US
Telephone Number	:	949-831-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 MAREBLU STE 210
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3044
Country	:	US
Telephone Number	:	949-831-1001
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SEAN R THOMAS
Credential	:	M.D.
Telephone Number	:	760-364-5149

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	12/02/2014

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