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General NPI Number Information
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NPI Number | 1689921884
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Entity Type | Organization
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Legal Business Name | TIMOTHY J DAUWALDER DO A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 150 W 1ST ST SUITE 300
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City | CLAREMONT
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State | CA
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Zip | 91711-4750
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Country | US
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Telephone | 909-621-2522
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Fax | 909-941-6974
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Provider Business Mailing Address
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Address Line | 150 W 1ST ST SUITE 300
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City | CLAREMONT
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State | CA
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Zip | 91711-4750
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Country | US
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Telephone | 909-621-2522
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Fax | 909-941-6974
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY J DAUWALDER
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Credential | DO
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Telephone | 909-621-2522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A7875
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License Number State | CA
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