Provider Demographics
NPI:1265778989
Name:THOMPSON, DONNA JO (HHP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JO
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CAMINO KATIA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-9420
Mailing Address - Country:US
Mailing Address - Phone:949-285-1300
Mailing Address - Fax:
Practice Address - Street 1:910 S EL CAMINO REAL
Practice Address - Street 2:STE. F 7
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4279
Practice Address - Country:US
Practice Address - Phone:949-285-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist