Healthcare Provider Details

I. General information

NPI: 1578766457
Provider Name (Legal Business Name): TIMOTHY B DYMOND ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 17TH ST
SAN FRANCISCO CA
94114-2021
US

IV. Provider business mailing address

3705 17TH ST
SAN FRANCISCO CA
94114-2021
US

V. Phone/Fax

Practice location:
  • Phone: 415-307-2092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: