Provider Demographics
NPI:1992760573
Name:THOMAS, CHERYL ANN (MD)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 10159
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-0050
Mailing Address - Country:US
Mailing Address - Phone:949-270-2100
Mailing Address - Fax:949-650-4458
Practice Address - Street 1:195 S C ST
Practice Address - Street 2:STE 100
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3666
Practice Address - Country:US
Practice Address - Phone:714-669-4700
Practice Address - Fax:714-669-4707
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG066547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG066547OtherMEDICAL LICENSE #
CAG066547OtherMEDICAL LICENSE #
F05503Medicare UPIN
CABT2015154OtherDEA #