Basic Information
| Provider Information | |||||||||
| NPI: | 1649316340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAZIN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20812 HILLSDALE RD | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925082529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516750970 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9707 MAGNOLIA AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925033609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513585810 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT32218 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.