Healthcare Provider Details

I. General information

NPI: 1528113479
Provider Name (Legal Business Name): TIMOTHY LEE NORCROSS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 PENINSULA CENTER STE A
ROLLING HILLS ESTATES CA
90274
US

IV. Provider business mailing address

65 PENINSULA CTR SUITE A
ROLLING HILLS ESTATES CA
90274-3506
US

V. Phone/Fax

Practice location:
  • Phone: 310-541-8919
  • Fax: 310-541-8959
Mailing address:
  • Phone: 310-541-8919
  • Fax: 310-541-8959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A9826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: