1629097399 NPI number — TIMOTHY D HOOPER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629097399 NPI number — TIMOTHY D HOOPER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOPER
Provider First Name:
TIMOTHY
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARE
Provider Other First Name:
SONORA
Provider Other Middle Name:
PRIMARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1629097399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18701 TIFFENI DR
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
TWAIN HARTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95383-9406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-586-1400
Provider Business Mailing Address Fax Number:
209-586-6748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13951 MONO WAY
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-4856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-532-3370
Provider Business Practice Location Address Fax Number:
209-532-3340
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G55188 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X , with the licence number: G55188 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: G55188 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0000X , with the licence number: G55188 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ20686Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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