Healthcare Provider Details

I. General information

NPI: 1962895342
Provider Name (Legal Business Name): TIMOTHY JOSEPH ROSS EAMP, L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 SANTA CLARA BLVD
BIG BEAR LAKE CA
92315-9816
US

IV. Provider business mailing address

PO BOX 6657
BIG BEAR LAKE CA
92315-6657
US

V. Phone/Fax

Practice location:
  • Phone: 714-915-2301
  • Fax:
Mailing address:
  • Phone: 714-915-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 60432768
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: