Provider Demographics
NPI:1720187404
Name:TIMOTHY MARESH MD, INC,.
Entity Type:Organization
Organization Name:TIMOTHY MARESH MD, INC,.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-451-7944
Mailing Address - Street 1:15725 POMERADO RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2068
Mailing Address - Country:US
Mailing Address - Phone:858-451-7944
Mailing Address - Fax:858-451-0082
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:SUITE 207
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:858-451-7944
Practice Address - Fax:858-451-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52620174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACNC302466Medicaid
CAA52304Medicare UPIN