Provider Demographics
NPI:1790174233
Name:TOMSON, TOMI (PA-C)
Entity Type:Individual
Prefix:
First Name:TOMI
Middle Name:
Last Name:TOMSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 FIORE TER
Mailing Address - Street 2:APT I 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5640
Mailing Address - Country:US
Mailing Address - Phone:616-889-5763
Mailing Address - Fax:
Practice Address - Street 1:6136 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2502
Practice Address - Country:US
Practice Address - Phone:619-303-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant