Provider Demographics
NPI:1164966081
Name:THOMAS, AUSTIN MICHAEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:MICHAEL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S. OAK AVE
Mailing Address - Street 2:#4
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107
Mailing Address - Country:US
Mailing Address - Phone:509-845-1023
Mailing Address - Fax:
Practice Address - Street 1:45 S OAK AVE
Practice Address - Street 2:#4
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4009
Practice Address - Country:US
Practice Address - Phone:509-845-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132662367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered