Provider Demographics
NPI:1760579577
Name:TIMPA, DARRELL (IDC)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:TIMPA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13912 CAPEWOOD LN
Mailing Address - Street 2:APT 304
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-6407
Mailing Address - Country:US
Mailing Address - Phone:858-674-7519
Mailing Address - Fax:
Practice Address - Street 1:SWMI
Practice Address - Street 2:34101 FARENHOLT AVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:619-532-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman