Healthcare Provider Details

I. General information

NPI: 1366991663
Provider Name (Legal Business Name): TIMOTHY CHRISTOPHER MIGUEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E LAKE AVE
WATSONVILLE CA
95076-4826
US

IV. Provider business mailing address

335 E LAKE AVE
WATSONVILLE CA
95076-4826
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-6445
  • Fax: 831-728-6249
Mailing address:
  • Phone: 831-728-6445
  • Fax: 831-728-6249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC5596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: