Provider Demographics
NPI:1992733307
Name:MESSINGER, THAO (PA C)
Entity type:Individual
Prefix:MS
First Name:THAO
Middle Name:
Last Name:MESSINGER
Suffix:
Gender:F
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 1:25814 SKYLARK DR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7314
Mailing Address - Country:US
Mailing Address - Phone:480-586-7542
Mailing Address - Fax:
Practice Address - Street 1:23365 HAWTHORNE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3736
Practice Address - Country:US
Practice Address - Phone:480-586-7542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56733363AS0400X
AZ3321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ988595Medicaid
AZ988595Medicaid