Provider Demographics
NPI:1700371366
Name:DIPERI, TIMOTHY PHILIP JR (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PHILIP
Last Name:DIPERI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4714
Mailing Address - Country:US
Mailing Address - Phone:423-930-7383
Mailing Address - Fax:
Practice Address - Street 1:8700 BEVERLY BLVD STE 8215NT
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:423-930-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000XMedicaid