Provider Demographics
NPI:1689818015
Name:TIMONY, THERESA COONEY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:COONEY
Last Name:TIMONY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 EXECUTIVE DR
Mailing Address - Street 2:STE 227
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3020
Mailing Address - Country:US
Mailing Address - Phone:858-810-8787
Mailing Address - Fax:858-987-5825
Practice Address - Street 1:7011 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6307
Practice Address - Country:US
Practice Address - Phone:858-810-8787
Practice Address - Fax:858-987-5825
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95039081163W00000X
CA95007497363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse