Provider Demographics
NPI:1679891253
Name:WIGAL, TIM L (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:L
Last Name:WIGAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19722 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2404
Mailing Address - Country:US
Mailing Address - Phone:949-824-1812
Mailing Address - Fax:949-824-1811
Practice Address - Street 1:19722 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2404
Practice Address - Country:US
Practice Address - Phone:949-824-1812
Practice Address - Fax:949-824-1811
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14209103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical