Provider Demographics
NPI:1124993050
Name:RADER, THOMAS RHOADES
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RHOADES
Last Name:RADER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RHOADES
Other - Middle Name:THOMAS
Other - Last Name:RADER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3006 PACIFIC AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3006 PACIFIC AVE APT 3
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-4475
Practice Address - Country:US
Practice Address - Phone:323-270-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program