Provider Demographics
NPI:1922102318
Name:DESIMIO, THOMAS MARTIN (RN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MARTIN
Last Name:DESIMIO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 DRAKE LN
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-5464
Mailing Address - Country:US
Mailing Address - Phone:510-220-0706
Mailing Address - Fax:510-724-1576
Practice Address - Street 1:2126 DRAKE LN
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-5464
Practice Address - Country:US
Practice Address - Phone:510-220-0706
Practice Address - Fax:510-724-1576
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552866163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy