Provider Demographics
NPI:1801507694
Name:ACHESON, TIMOTHY CLAYTON ANTON
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CLAYTON ANTON
Last Name:ACHESON
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 1:12665 VILLAGE LN APT 4505
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2863
Mailing Address - Country:US
Mailing Address - Phone:619-507-2085
Mailing Address - Fax:
Practice Address - Street 1:12665 VILLAGE LN APT 4505
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2863
Practice Address - Country:US
Practice Address - Phone:619-507-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program