Individual
MR. THOMAS LAROY KOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
22431 ANTONIO PKWY # B160-613, RANCHO SANTA MARGARITA, CA 92688-2804
(855) 727-2251
(855) 727-2251
Mailing address
22431 ANTONIO PKWY # B160-613, RANCHO SANTA MARGARITA, CA 92688-2804
(855) 727-2251
(855) 727-2251
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
PA11655
CA
363A00000X
Physician Assistant
PA11655
CA
363AS0400X
Surgical Physician Assistant
Primary
PA11655
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11655
PHYSICIAN ASSISTANT
CA
Enumeration date
07/09/2006
Last updated
11/10/2022
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