Healthcare Provider Details

I. General information

NPI: 1265530406
Provider Name (Legal Business Name): TIMOTHY PATRICK MCGUIRE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E VICTORIA ST
CARSON CA
90747-0001
US

IV. Provider business mailing address

588 ROSECRANS AVE
MANHATTAN BEACH CA
90266-3470
US

V. Phone/Fax

Practice location:
  • Phone: 310-243-3876
  • Fax:
Mailing address:
  • Phone: 310-243-3876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: