Provider Demographics
NPI:1003215088
Name:THOMSON, GLORIA PATRICIA (RN, BSN, PHN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:PATRICIA
Last Name:THOMSON
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5469 KEARNY VILLA RD STE 2000
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1144
Mailing Address - Country:US
Mailing Address - Phone:858-636-3573
Mailing Address - Fax:858-467-9045
Practice Address - Street 1:5469 KEARNY VILLA RD STE 2000
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1144
Practice Address - Country:US
Practice Address - Phone:858-636-3573
Practice Address - Fax:858-467-9045
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA572884163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse