Healthcare Provider Details

I. General information

NPI: 1801507694
Provider Name (Legal Business Name): MR. TIMOTHY CLAYTON ANTON ACHESON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 VILLAGE LN APT 4505
PLAYA VISTA CA
90094-2863
US

IV. Provider business mailing address

12665 VILLAGE LN APT 4505
PLAYA VISTA CA
90094-2863
US

V. Phone/Fax

Practice location:
  • Phone: 619-507-2085
  • Fax:
Mailing address:
  • Phone: 619-507-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: