Provider Demographics
NPI:1699412338
Name:WARES, TIMOTHY ROBERT
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:WARES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 HIGHWAY 132
Mailing Address - Street 2:
Mailing Address - City:COULTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95311-9722
Mailing Address - Country:US
Mailing Address - Phone:209-404-8009
Mailing Address - Fax:
Practice Address - Street 1:3660 HIGHWAY 132
Practice Address - Street 2:
Practice Address - City:COULTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95311-9722
Practice Address - Country:US
Practice Address - Phone:209-404-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-15
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant