Provider Demographics
NPI:1528452604
Name:GANIRON, TIMOTHY MICHAEL (LVN)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:GANIRON
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 E FARGO AVE
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-1271
Mailing Address - Country:US
Mailing Address - Phone:559-362-5944
Mailing Address - Fax:
Practice Address - Street 1:432 E FARGO AVE
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-1271
Practice Address - Country:US
Practice Address - Phone:559-362-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247813164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse