Provider Demographics
NPI:1659889921
Name:THOMAT, ANA LAURA (PHD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LAURA
Last Name:THOMAT
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 1:4410 ALTA MIRA DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7005
Mailing Address - Country:US
Mailing Address - Phone:619-880-6690
Mailing Address - Fax:619-684-3773
Practice Address - Street 1:4410 ALTA MIRA DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7005
Practice Address - Country:US
Practice Address - Phone:619-880-6690
Practice Address - Fax:619-684-3773
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical