Basic Information
Provider Information
NPI: 1184910390
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMAS
FirstName: GISHA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1450 TREAT BLVD # 300
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945972168
CountryCode: US
TelephoneNumber: 9259522828
FaxNumber: 9259522850
Practice Location
Address1: 3466 MT. DIABLO BLVD
Address2: #C104
City: WALNUT CREEK
State: CA
PostalCode: 94596
CountryCode: US
TelephoneNumber: 9252967490
FaxNumber: 9252838687
Other Information
ProviderEnumerationDate: 06/27/2011
LastUpdateDate: 10/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X4301098526MIN Allopathic & Osteopathic PhysiciansInternal Medicine 
207R00000XA129457CAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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