Individual
LARRY JAMES THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7200 BANCROFT AVE, EASTMONT TOWN CENTER BLDG. B SUITE 133, OAKLAND, CA 94605-2403
(510) 553-8500
(510) 553-8550
Mailing address
15990 MATEO ST APT 5, SAN LEANDRO, CA 94578-3021
(510) 553-8500
(519) 553-8550
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801983960
ICM
CA
Enumeration date
01/16/2007
Last updated
07/08/2007
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