Provider Demographics
NPI:1952510240
Name:TOMIC, JODY CARMEN (PA)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:CARMEN
Last Name:TOMIC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-0808
Mailing Address - Country:US
Mailing Address - Phone:925-424-4526
Mailing Address - Fax:925-422-6790
Practice Address - Street 1:7000 EAST AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-9698
Practice Address - Country:US
Practice Address - Phone:925-424-4526
Practice Address - Fax:925-422-6790
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20047363A00000X
CAPA20047363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical