Provider Demographics
NPI:1861013351
Name:THOMAS, CASEY (RD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20662 EGRET LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5504
Mailing Address - Country:US
Mailing Address - Phone:310-365-5248
Mailing Address - Fax:
Practice Address - Street 1:20662 EGRET LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-5504
Practice Address - Country:US
Practice Address - Phone:310-365-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86099983133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered