Provider Demographics
NPI:1447779400
Name:O'NEIL, TIMOTHY JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:O'NEIL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:TIMOTHY
Other - Middle Name:JOSEPH
Other - Last Name:ONEIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2567 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2119
Mailing Address - Country:US
Mailing Address - Phone:831-295-1625
Mailing Address - Fax:
Practice Address - Street 1:2567 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2119
Practice Address - Country:US
Practice Address - Phone:831-295-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant