Provider Demographics
NPI:1922677210
Name:THOMPSON, RICHARD JASON (LVN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JASON
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 1:14850 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4677
Mailing Address - Country:US
Mailing Address - Phone:818-787-2222
Mailing Address - Fax:818-904-3502
Practice Address - Street 1:14850 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4677
Practice Address - Country:US
Practice Address - Phone:818-787-2222
Practice Address - Fax:818-904-3502
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA227811207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services