Individual
MR. TIMOTHY EARL WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RDO
Contact information
Practice address
227 N JACKSON AVE, SAN JOSE, CA 95116-1603
(408) 729-7115
(408) 729-7115
Mailing address
980 S BAYWOOD AVE, SAN JOSE, CA 95128-3310
(408) 985-8265
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
D3539
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1713912
—
CA
Enumeration date
05/11/2007
Last updated
07/09/2007
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