Provider Demographics
NPI:1346691714
Name:THORNTON, BILLY J
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:J
Last Name:THORNTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27699 JEFFERSON AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2697
Mailing Address - Country:US
Mailing Address - Phone:855-427-2778
Mailing Address - Fax:
Practice Address - Street 1:27699 JEFFERSON AVE STE 111
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2697
Practice Address - Country:US
Practice Address - Phone:855-427-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901646363LP0808X
CA95020726363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health