Provider Demographics
NPI:1467493155
Name:O'NEILL, TIMOTHY F (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:F
Last Name:O'NEILL
Suffix:
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 1:5300 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2808
Mailing Address - Country:US
Mailing Address - Phone:562-430-7533
Mailing Address - Fax:562-430-8055
Practice Address - Street 1:5300 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2808
Practice Address - Country:US
Practice Address - Phone:562-430-7533
Practice Address - Fax:562-430-8055
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65895207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G658950Medicaid
WG65895AMedicare PIN
CA00G658950Medicaid