Provider Demographics
NPI:1689427643
Name:THOMPSON, HEZKIAH JOAQUIN III
Entity Type:Individual
Prefix:MR
First Name:HEZKIAH
Middle Name:JOAQUIN
Last Name:THOMPSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 TERMINAL WAY STE 208
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2168
Mailing Address - Country:US
Mailing Address - Phone:775-686-6021
Mailing Address - Fax:
Practice Address - Street 1:316 MAINE ST APT 2
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1425
Practice Address - Country:US
Practice Address - Phone:775-354-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide