Provider Demographics
NPI:1245676717
Name:COBB, THOMAS ALAN (LAC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:COBB
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 TELEGRAPH AVE
Mailing Address - Street 2:APT. 5
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1155
Mailing Address - Country:US
Mailing Address - Phone:858-342-5764
Mailing Address - Fax:
Practice Address - Street 1:6605 TELEGRAPH AVE
Practice Address - Street 2:APT. 5
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1155
Practice Address - Country:US
Practice Address - Phone:858-342-5764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist