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General NPI Number Information
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NPI Number | 1710296439
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Entity Type | Organization
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Legal Business Name | TIMOTHY P. HUSTON MD, INC
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 27231 LA PAZ RD STE A
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-3627
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Country | US
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Telephone | 949-643-9111
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Fax | 949-643-8916
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Provider Business Mailing Address
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Address Line | 31722 AVENIDA EVITA
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3402
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Country | US
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Telephone | 949-643-9111
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Fax | 949-643-8916
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY P HUSTON
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Credential | MD
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Telephone | 949-643-9111
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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 | G44816
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License Number State | CA
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