Healthcare Provider Details

I. General information

NPI: 1013919455
Provider Name (Legal Business Name): TIMOTHY A BRIESKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 VISTA WAY
OCEANSIDE CA
92056
US

IV. Provider business mailing address

7093 HERON CIR
CARLSBAD CA
92011-3975
US

V. Phone/Fax

Practice location:
  • Phone: 760-940-5606
  • Fax: 760-940-4007
Mailing address:
  • Phone: 760-814-2045
  • Fax: 310-538-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number43799
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: