Healthcare Provider Details

I. General information

NPI: 1063400711
Provider Name (Legal Business Name): TIMOTHY JOHN DUNNIGAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 CAMINO DE LA SIESTA SUITE 306
SAN DIEGO CA
92108-3116
US

IV. Provider business mailing address

5030 CAMINO DE LA SIESTA SUITE 306
SAN DIEGO CA
92108-3116
US

V. Phone/Fax

Practice location:
  • Phone: 619-889-6711
  • Fax: 619-297-9108
Mailing address:
  • Phone: 619-889-6711
  • Fax: 619-297-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: