Provider Demographics
NPI:1962289934
Name:THOMAS, ROBERT GENE (BACHELORS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GENE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:BACHELORS
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BACHELORS
Mailing Address - Street 1:1051 ROCK SPRINGS RD APT 234
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2446
Mailing Address - Country:US
Mailing Address - Phone:442-248-7524
Mailing Address - Fax:
Practice Address - Street 1:110 CIVIC CENTER DR STE 207
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6039
Practice Address - Country:US
Practice Address - Phone:760-659-6574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician