Provider Demographics
NPI:1558842799
Name:THUMWANIT, NICHA
Entity Type:Individual
Prefix:
First Name:NICHA
Middle Name:
Last Name:THUMWANIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18744 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6049
Mailing Address - Country:US
Mailing Address - Phone:562-275-1552
Mailing Address - Fax:
Practice Address - Street 1:18744 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6049
Practice Address - Country:US
Practice Address - Phone:562-275-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20705225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist