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NPI Code Detail

MEDICARE: TIM BOISSEY

MEDICARE: TIM BOISSEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistCA

General Provider Information

NPI Number : 1598132433
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIM BOISSEY
Provider Business Mailing Address
First Line : 2041 N COMMONWEALTH AVE APT 103
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-2840
Country : US
Telephone Number : 336-575-9371
Fax Number :
Provider Business Practice Location Address
First Line : 2041 N COMMONWEALTH AVE APT 103
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-2840
Country : US
Telephone Number : 336-575-9371
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2015
Last Update Date : 08/26/2015

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Directions to “ TIM BOISSEY ” Practice Location

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