Provider Demographics
NPI:1760066542
Name:THOMAS, MARIA GUADALUPE III (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:GUADALUPE
Last Name:THOMAS
Suffix:III
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:1317 W FOOTHILL BLVD STE 148
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3675
Mailing Address - Country:US
Mailing Address - Phone:909-981-5882
Mailing Address - Fax:909-373-2828
Practice Address - Street 1:1317 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3676
Practice Address - Country:US
Practice Address - Phone:909-981-5882
Practice Address - Fax:909-373-2828
Is Sole Proprietor?:No
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95016192363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care