Individual provider · Type 1 NPI
Heaven Thompson
Medical Physician Assistant · Venice, CA
NPI number
1104542224
Active
Practice location
503 Ocean Front Walk
Venice, CA 90291-2403
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | None listed |
Medical Physician Assistant: Definition to come...
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About NPI 1104542224
Heaven Thompson's National Provider Identifier is 1104542224, issued on Oct 19, 2022. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Venice, CA. The record was last updated on Jan 27, 2025.