Healthcare Provider Details

I. General information

NPI: 1063353829
Provider Name (Legal Business Name): TIMOTHY CASPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15791 BEAR VALLEY RD
HESPERIA CA
92345-1746
US

IV. Provider business mailing address

11946 CRANDALL CT
VICTORVILLE CA
92392-6813
US

V. Phone/Fax

Practice location:
  • Phone: 760-949-1231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: