Healthcare Provider Details

I. General information

NPI: 1003348061
Provider Name (Legal Business Name): TIMOTHY MORLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23451 MADISON ST STE 340
TORRANCE CA
90505-4762
US

IV. Provider business mailing address

759 CHESTNUT ST
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-6864
  • Fax: 310-373-6065
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA193849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: