Provider Demographics
NPI:1417994567
Name:METZ, THOMAS J (MS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:METZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S CHINA LAKE BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-4049
Mailing Address - Country:US
Mailing Address - Phone:760-375-9399
Mailing Address - Fax:760-375-9399
Practice Address - Street 1:121 S CHINA LAKE BLVD
Practice Address - Street 2:STE. B
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-4049
Practice Address - Country:US
Practice Address - Phone:760-375-9399
Practice Address - Fax:760-375-9399
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1278231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist