Provider Demographics
NPI:1780980227
Name:THOMAS, LINDSAY RAE (PA-C)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:RAE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20255 ESTUARY LANE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5606
Mailing Address - Country:US
Mailing Address - Phone:949-584-8503
Mailing Address - Fax:714-633-5615
Practice Address - Street 1:1310 WEST STEWART DRIVE
Practice Address - Street 2:SUITE 508
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3856
Practice Address - Country:US
Practice Address - Phone:714-633-2111
Practice Address - Fax:714-633-5615
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant