Provider Demographics
NPI:1124199427
Name:SIMMONS, TIMOTHY CURTIS SR (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CURTIS
Last Name:SIMMONS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 E PENINSULA CENTER DRIVE #134
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274
Mailing Address - Country:US
Mailing Address - Phone:562-257-6110
Mailing Address - Fax:562-391-4481
Practice Address - Street 1:3816 WOODRUFF AVE STE 411
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2146
Practice Address - Country:US
Practice Address - Phone:562-257-6110
Practice Address - Fax:562-391-4481
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44370Medicare UPIN