Healthcare Provider Details

I. General information

NPI: 1639567498
Provider Name (Legal Business Name): MR. TIMOTHY LENARD MAY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 SANTA ANITA AVE SUITE #112B
EL MONTE CA
91733-1369
US

IV. Provider business mailing address

3131 SANTA ANITA AVE SUITE #112B
EL MONTE CA
91733-1369
US

V. Phone/Fax

Practice location:
  • Phone: 626-636-2370
  • Fax: 626-453-3415
Mailing address:
  • Phone: 626-636-2370
  • Fax: 626-453-3415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1213510915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: