Provider Demographics
NPI:1396266318
Name:THOMAS, CYNTHIA M
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6407 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-7224
Mailing Address - Country:US
Mailing Address - Phone:318-347-2606
Mailing Address - Fax:
Practice Address - Street 1:6407 SANTA MONICA BLVD.
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119
Practice Address - Country:US
Practice Address - Phone:318-347-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver