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Organization
TIM MCNICOLL MD INC
Active
Organization
TIM MCNICOLL MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY J MCNICOLL MD (PRESIDENT/OWNER)
(805) 527-6424
Entity
Organization
Contact information
Practice address
2876 SYCAMORE DR, SUITE 101, SIMI VALLEY, CA 93065-1530
(805) 527-6424
(805) 522-0115
Mailing address
2876 SYCAMORE DR, SUITE 101, SIMI VALLEY, CA 93065-1530
(805) 527-6424
(805) 522-0115
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G48100
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G481000
—
CA
Enumeration date
11/21/2008
Last updated
02/03/2009
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