Provider Demographics
NPI:1982605986
Name:HARWARD, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HARWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W LA VETA AVE STE 850
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4218
Mailing Address - Country:US
Mailing Address - Phone:714-560-4450
Mailing Address - Fax:714-560-4455
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:STE. 850
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4225
Practice Address - Country:US
Practice Address - Phone:714-560-4450
Practice Address - Fax:714-560-4455
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG467972086S0129X
IN01084955A2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G467970Medicaid
00G467970OtherBLUE SHIELD OF CA
00G467970 M46OtherCALOPTIMA
050069CE11040OtherTRAILBLAZER
770003176OtherRAILROAD MEDICARE
00G467970 M46OtherCALOPTIMA
E11040Medicare UPIN