Provider Demographics
NPI:1518783810
Name:THOMAS, EDWARD BERNARD II
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:BERNARD
Last Name:THOMAS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5084 MOSCATO CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-4137
Mailing Address - Country:US
Mailing Address - Phone:707-862-1017
Mailing Address - Fax:
Practice Address - Street 1:4849 LONE TREE WAY STE C
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8644
Practice Address - Country:US
Practice Address - Phone:925-391-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician