Healthcare Provider Details

I. General information

NPI: 1629361027
Provider Name (Legal Business Name): TIMOTHY LI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23811 WASHINGTON AVE # C110-220
MURRIETA CA
92562-2275
US

IV. Provider business mailing address

11555 1/2 POTRERO RD RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
BANNING CA
92220-6946
US

V. Phone/Fax

Practice location:
  • Phone: 951-231-1385
  • Fax: 866-686-7693
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A 12572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: