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Individual

MRS. TERESA N/A REA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
N/A

Contact information

Practice address
813 ROSANA PLACE, NIPOMO, CA 93444-5605
(805) 929-4891
Mailing address
PO BOX 727, PISMO BEACH, CA 93448-0727
(805) 929-4891

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
40030
CA

Other

Enumeration date
09/14/2007
Last updated
12/16/2008
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