Provider Demographics
NPI:1437546512
Name:TAYLOR, TIMOTHY JUSTIN (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JUSTIN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 S EL CAMINO REAL STE 117-122
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6203
Mailing Address - Country:US
Mailing Address - Phone:760-730-8060
Mailing Address - Fax:760-730-8061
Practice Address - Street 1:2170 S EL CAMINO REAL STE 117-122
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6203
Practice Address - Country:US
Practice Address - Phone:760-730-8060
Practice Address - Fax:760-730-8061
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A17483207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program