Basic Information
| Provider Information | |||||||||
| NPI: | 1376552638 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLDEN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E PALOMAR ST | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919131800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232808955 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 751 MEDICAL CENTER CT | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919116617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194825800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 10/26/2007 | ||||||||
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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 | 207R00000X | 39125 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A99762 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1376552638 | 01 | CA | NPI | OTHER |