Provider Demographics
NPI:1639379191
Name:THOMAS, VERONICA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17662 IRVINE BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3149
Mailing Address - Country:US
Mailing Address - Phone:714-730-7090
Mailing Address - Fax:714-731-7119
Practice Address - Street 1:17662 IRVINE BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3149
Practice Address - Country:US
Practice Address - Phone:714-730-7090
Practice Address - Fax:714-731-7119
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8940103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical