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Individual

HEAVEN THOMPSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
503 OCEAN FRONT WALK, VENICE, CA 90291-2403
(310) 392-3070
Mailing address
503 OCEAN FRONT WALK, VENICE, CA 90291-2403
(310) 392-3070

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
NA
CA
Enumeration date
10/19/2022
Last updated
01/27/2025
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