Provider Demographics
NPI:1831558832
Name:THOMAS, SANDRA DURON (D1007310950)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DURON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:D1007310950
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9534 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6577
Mailing Address - Country:US
Mailing Address - Phone:562-461-9272
Mailing Address - Fax:
Practice Address - Street 1:2501 W. EL SEGUNDO BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:323-754-2816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD1007310950101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)