Healthcare Provider Details

I. General information

NPI: 1366905473
Provider Name (Legal Business Name): TIMOTHY DANIEL COLLINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RIVERSIDE COMMUNITY HOSPITAL, 4445 MAGNOLIA AVE., GME OFFICE
RIVERSIDE CA
92501
US

IV. Provider business mailing address

RIVERSIDE COMMUNITY HOSPITAL, 4445 MAGNOLIA AVE., GME OFFICE
RIVERSIDE CA
92501
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3000
  • Fax:
Mailing address:
  • Phone: 951-788-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: