Provider Demographics
NPI:1982889135
Name:THORNSBERRY, DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:THORNSBERRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27020 ALICIA PKWY
Mailing Address - Street 2:STE G
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3420
Mailing Address - Country:US
Mailing Address - Phone:949-707-5734
Mailing Address - Fax:949-707-1924
Practice Address - Street 1:27020 ALICIA PKWY STE G
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3420
Practice Address - Country:US
Practice Address - Phone:949-707-5734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 19559363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant