Healthcare Provider Details

I. General information

NPI: 1538084637
Provider Name (Legal Business Name): TIMOTHY IMONI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6714 RUNWAY AVE
FONTANA CA
92336-4157
US

IV. Provider business mailing address

6714 RUNWAY AVE
FONTANA CA
92336-4157
US

V. Phone/Fax

Practice location:
  • Phone: 909-702-5222
  • Fax:
Mailing address:
  • Phone: 909-702-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN95379569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: