Provider Demographics
NPI:1033239389
Name:TIMMERMAN, MONICA (PSYCH TECH)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:PSYCH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 N ROBERTA WAY
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-9049
Mailing Address - Country:US
Mailing Address - Phone:559-781-5831
Mailing Address - Fax:
Practice Address - Street 1:1701 W KANAI AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1873
Practice Address - Country:US
Practice Address - Phone:559-782-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30207167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician