Provider Demographics
NPI:1609977859
Name:CANTY, TIMOTHY GILES SR (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GILES
Last Name:CANTY
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1846 CASTELLANA RD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3840
Mailing Address - Country:US
Mailing Address - Phone:858-454-4550
Mailing Address - Fax:858-454-1478
Practice Address - Street 1:3030 CHILDRENS WAY
Practice Address - Street 2:STE 401
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4232
Practice Address - Country:US
Practice Address - Phone:858-966-6717
Practice Address - Fax:858-966-6720
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG144182086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G144180Medicaid