Provider Demographics
NPI:1336175611
Name:THYMES, DEONZA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEONZA
Middle Name:NICOLE
Last Name:THYMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N SEPULVEDA BLVD # 144
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5111
Mailing Address - Country:US
Mailing Address - Phone:323-972-2445
Mailing Address - Fax:
Practice Address - Street 1:3858 W CARSON ST
Practice Address - Street 2:SUITE 121
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6709
Practice Address - Country:US
Practice Address - Phone:310-543-9333
Practice Address - Fax:310-405-0954
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88766174400000X, 207P00000X
VA0101259412207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI46030Medicare UPIN
CAAR186YMedicare PIN
CAWA88766AMedicare PIN
CAA88766Medicare ID - Type Unspecified