Provider Demographics
NPI:1053976456
Name:BEARDEN, TIMOTHY M (N/A)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:BEARDEN
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 BARNSTAPLE CT
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-5248
Mailing Address - Country:US
Mailing Address - Phone:951-442-4854
Mailing Address - Fax:
Practice Address - Street 1:4160 BARNSTAPLE CT
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-5248
Practice Address - Country:US
Practice Address - Phone:951-442-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)