Provider Demographics
NPI:1629361027
Name:LI, TIMOTHY (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11555 1/2 POTRERO RD
Mailing Address - Street 2:RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-6946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11555 1/2 POTRERO RD
Practice Address - Street 2:RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-6946
Practice Address - Country:US
Practice Address - Phone:951-849-4761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A 12572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine