Provider Demographics
NPI:1962708180
Name:THOMAS, MAHANTIE (LVN)
Entity type:Individual
Prefix:
First Name:MAHANTIE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 DENNERY RD
Mailing Address - Street 2:APT 78
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-8533
Mailing Address - Country:US
Mailing Address - Phone:858-397-3137
Mailing Address - Fax:
Practice Address - Street 1:2851 MEADOW LARK DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2709
Practice Address - Country:US
Practice Address - Phone:858-571-1964
Practice Address - Fax:858-571-1967
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211262164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse