Stacy, Timothy James

Stacy, Timothy James is an individual health care provider with primary practice located at 4955 Van Nuys Blvd Suite 502, Sherman Oaks CA 91403-1801. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as his primary health care specialty. Stacy, Timothy James can be contacted via phone (818) 325-0200.

Contact Information

Primary practice address
4955 Van Nuys Blvd Suite 502 Sherman Oaks CA 91403-1801
Phone: (818) 325-0200
Fax: (818) 325-0210
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 15005 California

Profile Details

NPI number 1457356479
LBN Legal business name Stacy, Timothy James
Credentials ACNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2005
Last updated Feb 23rd, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457356479 NPPES
California MEDICAID NP0150050
California MEDICAID 2571636
California Other B1180Z

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