Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | G46553 | CA |
NPI | 1043280076 |
---|---|
Provider Name | Dr. Timothy Mess |
First Address | Van Nuys, CA 91413-5608 |
Second Address | Van Nuys, CA 91405-3605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A50421 | (02) | CA |
G46553 | MEDICARE, PTAN (01) | CA |