MEDICARE: DR. JOHN TIMBERLAKE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	27332	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27332	OTHER	CA	BOARD OF PSYCHOLOGY

General Provider Information

NPI Number	:	1881075281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN TIMBERLAKE PSY.D.

Provider Business Mailing Address
First Line	:	11278 LOS ALAMITOS BLVD UNIT 912
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3958
Country	:	US
Telephone Number	:	562-452-3299
Fax Number	:

Provider Business Practice Location Address
First Line	:	11278 LOS ALAMITOS BLVD UNIT 912
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3958
Country	:	US
Telephone Number	:	562-452-3299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2015
Last Update Date	:	12/11/2025

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