Provider Demographics
NPI:1619243185
Name:THOMAS, MARIA JEANNETTE
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JEANNETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:M
Other - Middle Name:JEANNETTE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1600 GALVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2516
Mailing Address - Country:US
Mailing Address - Phone:209-303-8465
Mailing Address - Fax:209-491-0627
Practice Address - Street 1:1620 CUMMINS DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-6400
Practice Address - Country:US
Practice Address - Phone:209-622-1420
Practice Address - Fax:209-491-0627
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-UHWQSX175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist