Provider Demographics
NPI:1598573974
Name:THOMPSON, ELLA BLAISE
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:BLAISE
Last Name:THOMPSON
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 1:10331 CRAFTSMAN WAY APT 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3532
Mailing Address - Country:US
Mailing Address - Phone:619-961-7653
Mailing Address - Fax:
Practice Address - Street 1:10331 CRAFTSMAN WAY APT 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3532
Practice Address - Country:US
Practice Address - Phone:619-961-7653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula