Individual
DR. JERALD JOHN THANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2262 N STATE COLLEGE BLVD, FULLERTON, CA 92831-1361
(714) 990-2900
(714) 990-3133
Mailing address
2262 N STATE COLLEGE BLVD, FULLERTON, CA 92831-1361
(714) 990-2900
(714) 990-3133
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A46502
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A465020
—
CA
01
—
A46502
MEDICAL LICENSE NUMBER
CA
01
—
DL093Z
MEDICARE PTAN
CA
Enumeration date
07/05/2006
Last updated
08/22/2022
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