Basic Information
| Provider Information | |||||||||
| NPI: | 1164761219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARIAGA | ||||||||
| FirstName: | TIMOTHY | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 629 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934204251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052644387 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2178 JOHNSON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057814700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2013 | ||||||||
| LastUpdateDate: | 07/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | 36483 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.