Provider Demographics
NPI:1750418521
Name:THOMAS, GREGORY LLOYD
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:LLOYD
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 S SANTA FE AVE # 285
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5854
Mailing Address - Country:US
Mailing Address - Phone:760-945-4700
Mailing Address - Fax:760-945-0382
Practice Address - Street 1:271 S SANTA FE AVE # 285
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5854
Practice Address - Country:US
Practice Address - Phone:760-945-4700
Practice Address - Fax:760-945-0382
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43100332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02323FMedicaid
CA0486510001Medicare NSC