Provider Demographics
NPI:1790272599
Name:PARENTEAU, TIMOTHY RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RICHARD
Last Name:PARENTEAU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3609
Mailing Address - Country:US
Mailing Address - Phone:909-559-0907
Mailing Address - Fax:
Practice Address - Street 1:1530 9TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-3609
Practice Address - Country:US
Practice Address - Phone:909-559-0907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program