Provider Demographics
NPI:1255434544
Name:BOSMA, THOMAS A (PA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:BOSMA
Suffix:
Gender:M
Credentials:PA-C
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 1206
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1206
Mailing Address - Country:US
Mailing Address - Phone:805-964-3838
Mailing Address - Fax:805-683-3400
Practice Address - Street 1:504 W PUEBLO ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6211
Practice Address - Country:US
Practice Address - Phone:805-687-7719
Practice Address - Fax:805-682-2971
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18561363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1072617OtherNCCPA CERT#
CAPA18561OtherPA LICENSE
CAMB1460966OtherDEA CERT
CAOPA185610Medicare PIN