Basic Information
| Provider Information | |||||||||
| NPI: | 1760693642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIMBO | ||||||||
| FirstName: | ALPHA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8346 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902402228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232371934 | ||||||||
| FaxNumber: | 3237895648 | ||||||||
| Practice Location | |||||||||
| Address1: | 8220 S. SAN PEDRO ST. | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235652330 | ||||||||
| FaxNumber: | 3237895648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 05/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW22679 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.