Provider Demographics
NPI:1053324608
Name:REYNOLDS, TIMOTHY CUTLER (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CUTLER
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 WILSHIRE BLVD STE 1090
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6812
Mailing Address - Country:US
Mailing Address - Phone:310-478-1188
Mailing Address - Fax:310-478-9414
Practice Address - Street 1:11645 WILSHIRE BLVD STE 1090
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6812
Practice Address - Country:US
Practice Address - Phone:310-478-1188
Practice Address - Fax:310-478-9414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92815Medicare UPIN