MEDICARE: DR. TIMOTHY J. O'NEILL M.D.

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
1	207R00000X	Internal Medicine Physician	A67900	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A67900A	OTHER	CA	MEDICARE

General Provider Information

NPI Number	:	1831172295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY J. O'NEILL M.D.

Provider Business Mailing Address
First Line	:	4077 5TH AVE
Second Line	:	SUITE 503
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2105
Country	:	US
Telephone Number	:	858-245-9611
Fax Number	:	619-785-3282

Provider Business Practice Location Address
First Line	:	2850 6TH AVE
Second Line	:	SUITE 503
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6308
Country	:	US
Telephone Number	:	619-260-0670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	08/29/2016

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Directions to “ DR. TIMOTHY J. O'NEILL M.D.” Practice Location

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