Provider Demographics
NPI:1831242775
Name:PRESTON, THOMAS EDGAR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDGAR
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:STE 1290
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-386-6700
Mailing Address - Fax:818-386-6744
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:STE 1290
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-386-6700
Practice Address - Fax:818-386-6744
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG167662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry