Basic Information
| Provider Information | |||||||||
| NPI: | 1922677210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JASON | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14850 ROSCOE BLVD | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914024677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187872222 | ||||||||
| FaxNumber: | 8189043502 | ||||||||
| Practice Location | |||||||||
| Address1: | 14850 ROSCOE BLVD | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914024677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187872222 | ||||||||
| FaxNumber: | 8189043502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2021 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 227811 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.