Provider Demographics
NPI:1346388006
Name:DAVID A. THOMPSON, M.D., INC.
Entity Type:Organization
Organization Name:DAVID A. THOMPSON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-240-9041
Mailing Address - Street 1:435 ARDEN AVE
Mailing Address - Street 2:SUITE 560
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1130
Mailing Address - Country:US
Mailing Address - Phone:818-240-9041
Mailing Address - Fax:818-240-9043
Practice Address - Street 1:435 ARDEN AVE
Practice Address - Street 2:SUITE 560
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1130
Practice Address - Country:US
Practice Address - Phone:818-240-9041
Practice Address - Fax:818-240-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G190610Medicaid
1861469454OtherSOLE PROPIETOR NPI
CA00G190610Medicaid
1861469454OtherSOLE PROPIETOR NPI