Provider Demographics
NPI:1669655536
Name:WALTER ALAIN THOMAS, M.D.
Entity Type:Organization
Organization Name:WALTER ALAIN THOMAS, M.D.
Other - Org Name:WALTER ALAIN THOMAS, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:858-616-6400
Mailing Address - Street 1:3444 KEARNY VILLA RD
Mailing Address - Street 2:SUITE#303
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1959
Mailing Address - Country:US
Mailing Address - Phone:858-616-6400
Mailing Address - Fax:858-616-6936
Practice Address - Street 1:3444 KEARNY VILLA RD
Practice Address - Street 2:SUITE#3
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1959
Practice Address - Country:US
Practice Address - Phone:858-616-6400
Practice Address - Fax:858-616-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67913305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA67913OtherSTATE LICENSE
CA00A679130Medicaid
CAA67913OtherSTATE LICENSE
CAH44044Medicare UPIN