Provider Demographics
NPI:1093246266
Name:TIMMONS, KANDICE L
Entity Type:Individual
Prefix:DR
First Name:KANDICE
Middle Name:L
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 STUDEBAKER RD STE 700
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2684
Mailing Address - Country:US
Mailing Address - Phone:213-260-0021
Mailing Address - Fax:
Practice Address - Street 1:18000 STUDEBAKER RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2679
Practice Address - Country:US
Practice Address - Phone:213-260-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 29004103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical