Provider Demographics
NPI:1265603302
Name:THOMPSON, THERESA VALERO (NP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:VALERO
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 T ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1413
Mailing Address - Country:US
Mailing Address - Phone:559-459-6416
Mailing Address - Fax:559-459-2494
Practice Address - Street 1:1140 T STREET
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1413
Practice Address - Country:US
Practice Address - Phone:559-459-6416
Practice Address - Fax:559-459-2494
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8296363L00000X, 364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner