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NPI Code Detail

MEDICARE: MR. MAHMOOD BULKO TIMBO P.A

MEDICARE: MR. MAHMOOD BULKO TIMBO P.A
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
1363AM0700XMedical Physician Assistant15807CA

General Provider Information

NPI Number : 1881736452
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MAHMOOD BULKO TIMBO P.A
Provider Business Mailing Address
First Line : 14901 KINGSDALE AVE
Second Line :
City : LAWNDALE
State : CA
Zip : 90260-1405
Country : US
Telephone Number : 818-693-4189
Fax Number :
Provider Business Practice Location Address
First Line : 10300 COMPTON AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90002-3628
Country : US
Telephone Number : 818-693-4189
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 02/14/2012

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