Provider Demographics
NPI:1942447990
Name:RONALD THURSTON MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RONALD THURSTON MD A MEDICAL CORPORATION
Other - Org Name:RONALD C. THURSTON A MEDICAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-388-3337
Mailing Address - Street 1:400 MOBIL AVENUE
Mailing Address - Street 2:D9
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-388-3337
Mailing Address - Fax:805-388-1155
Practice Address - Street 1:400 MOBIL AVENUE
Practice Address - Street 2:#D9
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-388-3337
Practice Address - Fax:805-388-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-318562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34742Medicare UPIN