Healthcare Provider Details

I. General information

NPI: 1063117539
Provider Name (Legal Business Name): TIMOTHY TUSO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S PALISADE DR STE 203
SANTA MARIA CA
93454-8903
US

IV. Provider business mailing address

220 S PALISADE DR STE 203
SANTA MARIA CA
93454-8903
US

V. Phone/Fax

Practice location:
  • Phone: 805-354-7101
  • Fax: 805-354-7102
Mailing address:
  • Phone: 805-354-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA205663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: