Provider Demographics
NPI:1619138542
Name:THOMASIAN, SANDRA EDMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:EDMOND
Last Name:THOMASIAN
Suffix:
Gender:F
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:P.O. BOX 51258
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5558
Mailing Address - Country:US
Mailing Address - Phone:310-423-8600
Mailing Address - Fax:310-967-1800
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-1865
Practice Address - Country:US
Practice Address - Phone:310-423-8600
Practice Address - Fax:310-967-1800
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115451207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619138542Medicaid
CAFG671ZMedicare PIN