Provider Demographics
NPI:1700062056
Name:THOMAS, GEOFFREY RANDOLPH (LAC)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:RANDOLPH
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5252 BALBOA AVE
Mailing Address - Street 2:SUITE 804
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6906
Mailing Address - Country:US
Mailing Address - Phone:858-576-7494
Mailing Address - Fax:858-576-7494
Practice Address - Street 1:5252 BALBOA AVE
Practice Address - Street 2:SUITE 804
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6906
Practice Address - Country:US
Practice Address - Phone:858-576-7494
Practice Address - Fax:858-576-7494
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11931171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist