Provider Demographics
NPI:1902012354
Name:THOMAS, PATRICIA A (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:THOMAS
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 1:175 MADDUX AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2211
Mailing Address - Country:US
Mailing Address - Phone:415-822-2595
Mailing Address - Fax:
Practice Address - Street 1:120 BROADWAY
Practice Address - Street 2:STE 23
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1938
Practice Address - Country:US
Practice Address - Phone:510-236-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11325363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant