Healthcare Provider Details

I. General information

NPI: 1699216804
Provider Name (Legal Business Name): TIMOTHY FRINK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23501 CINEMA DR
SANTA CLARITA CA
91355-5428
US

IV. Provider business mailing address

1730 ROWLAND AVE
CAMARILLO CA
93010-3157
US

V. Phone/Fax

Practice location:
  • Phone: 661-288-4800
  • Fax:
Mailing address:
  • Phone: 562-547-9168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT29795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: