Provider Demographics
NPI:1245574094
Name:THOMPSON, ADORACION MAGTIBAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ADORACION
Middle Name:MAGTIBAY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 W AVENUE L4
Mailing Address - Street 2:
Mailing Address - City:QUARTZ HILL
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4223
Mailing Address - Country:US
Mailing Address - Phone:661-943-6540
Mailing Address - Fax:661-722-9894
Practice Address - Street 1:4017 W AVENUE L4
Practice Address - Street 2:
Practice Address - City:QUARTZ HILL
Practice Address - State:CA
Practice Address - Zip Code:93536-4223
Practice Address - Country:US
Practice Address - Phone:661-943-6540
Practice Address - Fax:661-722-9894
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD77176Medicare UPIN