Healthcare Provider Details

I. General information

NPI: 1154246692
Provider Name (Legal Business Name): MR. TIMOTHY P ROTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

16601 NIGHT HAWK LN
SAN DIEGO CA
92127-4457
US

IV. Provider business mailing address

1303 MOUNTAIN LAUREL RD
SAN MARCOS CA
92078-7435
US

V. Phone/Fax

Practice location:
  • Phone: 858-676-6312
  • Fax:
Mailing address:
  • Phone: 908-380-5320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250057779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: