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General NPI Number Information
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NPI Number | 1962516591
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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 | 08/19/2006
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 9381 E STOCKTON BLVD STE 216
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City | ELK GROVE
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State | CA
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Zip | 95624-5070
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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 | 9381 E STOCKTON BLVD STE 216
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City | ELK GROVE
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State | CA
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Zip | 95624-5070
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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 | PHYSICIAN
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Name | DR. 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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