Individual
THOMAS HATHORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
24352 FEATHERSTONE CANYON RD., LAKESIDE, CA 92040
(619) 797-7319
Mailing address
PO BOX 1279, LAKESIDE, CA 92040-0908
(858) 717-4322
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
370139AN
CA
Other
Enumeration date
10/02/2014
Last updated
10/02/2014
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