Provider Demographics
NPI:1689468522
Name:TRUITT, TIMOTHY R
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:R
Last Name:TRUITT
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 1:1250 ELLIOTT RD APT 13
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4172
Mailing Address - Country:US
Mailing Address - Phone:559-509-6266
Mailing Address - Fax:
Practice Address - Street 1:7200 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3280
Practice Address - Country:US
Practice Address - Phone:530-552-5154
Practice Address - Fax:530-877-5029
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty