Provider Demographics
NPI:1528268802
Name:THOMAS, NATASHA GEORGINA (MD)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:GEORGINA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NATASHA
Other - Middle Name:GEORGINA
Other - Last Name:TRIFUNOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19400 BEACH BLVD
Mailing Address - Street 2:UNIT 11
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2500
Mailing Address - Country:US
Mailing Address - Phone:714-968-1222
Mailing Address - Fax:714-968-1777
Practice Address - Street 1:19400 BEACH BLVD
Practice Address - Street 2:UNIT 11
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2500
Practice Address - Country:US
Practice Address - Phone:714-968-1222
Practice Address - Fax:714-968-1777
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS642-L207Q00000X
CAA115473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB212834OtherMEDICARE ID