Provider Demographics
NPI:1619040169
Name:SHIMA, THOMAS LYNN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LYNN
Last Name:SHIMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 THUNDER DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6010
Mailing Address - Country:US
Mailing Address - Phone:760-941-1440
Mailing Address - Fax:760-630-5477
Practice Address - Street 1:145 THUNDER DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6010
Practice Address - Country:US
Practice Address - Phone:760-941-1440
Practice Address - Fax:760-630-5477
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG338116207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G338160Medicaid
CA00G338160OtherBLUE CROSS BLUE SHIELD
CA5346695OtherAETNA
CAWG33816DMedicare PIN
CAW14833CMedicare PIN
CAA45689Medicare UPIN