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NPI Code Detail

MEDICARE: TERESA MIRANDA FUIAVA SUDCC

MEDICARE: TERESA MIRANDA FUIAVA SUDCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1598539058
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA MIRANDA FUIAVA SUDCC
Provider Business Mailing Address
First Line : 4141 PACIFIC HWY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-2030
Country : US
Telephone Number : 619-393-2024
Fax Number :
Provider Business Practice Location Address
First Line : 4141 PACIFIC HWY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-2030
Country : US
Telephone Number : 619-393-2024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2023
Last Update Date : 03/16/2026

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Directions to “ TERESA MIRANDA FUIAVA SUDCC” Practice Location

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