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General NPI Number Information
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NPI Number | 1427417559
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Entity Type | Organization
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Legal Business Name | TIMBERLAKE FAMILY PRACTICE A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 8120 TIMBERLAKE WAY #207
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City | SACRAMENTO
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State | CA
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Zip | 95823-5412
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Country | US
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Telephone | 916-691-5855
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Fax | 916-691-6066
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Provider Business Mailing Address
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Address Line | 8120 TIMBERLAKE WAY #207
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City | SACRAMENTO
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State | CA
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Zip | 95823-5412
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Country | US
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Telephone | 916-691-5855
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Fax | 916-691-6066
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOE LE
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Credential | MD
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Telephone | 916-691-5855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | CA
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