Individual
JOAN R THOMPSON
Active
Individual
JOAN R THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETITIAN
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
814574
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-1975
FQHC MEDICARE PART A
CA
05
—
FHC71021F
—
CA
01
—
HAP71021F
FPACT
CA
01
—
ZZZ29799Z
FQHC MEDICARE PART B
CA
Enumeration date
04/09/2007
Last updated
12/19/2007
Update your record
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