Healthcare Provider Details

I. General information

NPI: 1912279647
Provider Name (Legal Business Name): TIMOTHY T. CAMBRIDGE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TANH HUU PHAN D.C.

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 SUNOL BLVD STE 4
PLEASANTON CA
94566-7654
US

IV. Provider business mailing address

PO BOX 611466
SAN JOSE CA
95161-1466
US

V. Phone/Fax

Practice location:
  • Phone: 408-809-5638
  • Fax: 855-218-3370
Mailing address:
  • Phone: 408-809-5638
  • Fax: 855-218-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number11935
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: