Provider Demographics
NPI:1619243185
Name:THOMAS, MARIA JEANNETTE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JEANNETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:M
Other - Middle Name:JEANNETTE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1513 SHIPROCK CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8976
Mailing Address - Country:US
Mailing Address - Phone:209-303-8465
Mailing Address - Fax:
Practice Address - Street 1:1800 TULLY RD STE A2
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2923
Practice Address - Country:US
Practice Address - Phone:209-622-1420
Practice Address - Fax:209-491-0627
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator