Healthcare Provider Details

I. General information

NPI: 1679406896
Provider Name (Legal Business Name): TIMOTHY JOE MULLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TJ MULLIN

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 LILLARD DR
DAVIS CA
95618-5069
US

IV. Provider business mailing address

3624 LILLARD DR
DAVIS CA
95618-5069
US

V. Phone/Fax

Practice location:
  • Phone: 707-339-0614
  • Fax:
Mailing address:
  • Phone: 707-339-0614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberG54276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: