Provider Demographics
NPI:1821163809
Name:THOMPSON, ALBERT (LVN)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 SOUTH ST APT 246
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1361
Mailing Address - Country:US
Mailing Address - Phone:562-484-3385
Mailing Address - Fax:562-484-0269
Practice Address - Street 1:12353 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-8305
Practice Address - Country:US
Practice Address - Phone:562-484-3385
Practice Address - Fax:562-484-0269
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALVN179998164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1512013461Medicaid
CA1512013461Medicaid
CA1512013461Medicare ID - Type Unspecified