Basic Information
| Provider Information | |||||||||
| NPI: | 1811534092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LACERNA | ||||||||
| FirstName: | TIMOTHY JAMES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 KNOLL RD APT 35 | ||||||||
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| City: | SAN MARCOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920691576 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 247 E BOBIER DR | ||||||||
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| City: | VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920843026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609453033 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2019 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA50180 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.