Provider Demographics
NPI:1760947477
Name:THOMAS, WOODROW AUBREY III
Entity Type:Individual
Prefix:MR
First Name:WOODROW
Middle Name:AUBREY
Last Name:THOMAS
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 1:17071 VIA DE ANZA
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7915
Mailing Address - Country:US
Mailing Address - Phone:909-667-9293
Mailing Address - Fax:
Practice Address - Street 1:17071 VIA DE ANZA
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7915
Practice Address - Country:US
Practice Address - Phone:909-667-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst