Provider Demographics
NPI:1053771550
Name:TIMBOL, RAYMOND GREGORIO (CRT)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:GREGORIO
Last Name:TIMBOL
Suffix:
Gender:M
Credentials:CRT
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Mailing Address - Street 1:PO BOX 777851
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077
Mailing Address - Country:US
Mailing Address - Phone:702-893-3333
Mailing Address - Fax:702-893-0960
Practice Address - Street 1:2821 W HORIZON RIDGE PKWY.
Practice Address - Street 2:SUITE 101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-893-3333
Practice Address - Fax:702-893-0960
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1702161Medicaid
NVCCN294507Medicare PIN