Provider Demographics
NPI:1750547857
Name:THRONSON, JERRY
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:THRONSON
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:PO BOX 890341
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-0341
Mailing Address - Country:US
Mailing Address - Phone:951-767-2575
Mailing Address - Fax:951-767-0951
Practice Address - Street 1:38400 SAN IGNACIO RD
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-9488
Practice Address - Country:US
Practice Address - Phone:951-767-2575
Practice Address - Fax:951-767-0951
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-075707174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist