Provider Demographics
NPI:1700106564
Name:TIMOTHY J KILLEEN MD INC
Entity Type:Organization
Organization Name:TIMOTHY J KILLEEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KILLEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-694-4304
Mailing Address - Street 1:29645 RANCHO CALIFORNIA RD
Mailing Address - Street 2:STE. 226
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6200
Mailing Address - Country:US
Mailing Address - Phone:951-694-4304
Mailing Address - Fax:951-694-4307
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD
Practice Address - Street 2:STE. 226
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6200
Practice Address - Country:US
Practice Address - Phone:951-694-4304
Practice Address - Fax:951-694-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00553640207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52932Medicare UPIN
CA00G553640Medicare PIN