Provider Demographics
NPI:1215583257
Name:THOMAS S TOOMA M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THOMAS S TOOMA M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:CRUZADO
Authorized Official - Last Name:HOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-554-4688
Mailing Address - Street 1:75 ENTERPRISE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2626
Mailing Address - Country:US
Mailing Address - Phone:949-554-4688
Mailing Address - Fax:949-243-7467
Practice Address - Street 1:3075 HEALTH CENTER DR STE 403
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2773
Practice Address - Country:US
Practice Address - Phone:858-278-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty