Provider Demographics
NPI:1861932626
Name:MALONE, TIMOTHY J
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:MALONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3903
Mailing Address - Country:US
Mailing Address - Phone:619-487-9321
Mailing Address - Fax:844-754-3423
Practice Address - Street 1:4636 EDGEWARE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4701
Practice Address - Country:US
Practice Address - Phone:619-347-8052
Practice Address - Fax:844-754-3423
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies