Individual
MR. TIMOTHY R DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1501 5TH AVE, SUITE 100, SAN DIEGO, CA 92101-3291
(619) 461-3717
(619) 461-5663
Mailing address
12285 SCRIPPS POWAY PKWY, POWAY, CA 92064-6149
(951) 708-6508
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA12169
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA12169
CALIFORNIA LICENSE
CA
Enumeration date
09/09/2011
Last updated
09/27/2018
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