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NPI Code Detail

MEDICARE: TERESA R MALONE

MEDICARE: TERESA R MALONE
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
1163W00000XRegistered Nurse463727CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112886OTHERCANURSING CERTIFICATE
2463727OTHERCANURSE PRACTITIONER

General Provider Information

NPI Number : 1699801100
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA R MALONE
Provider Business Mailing Address
First Line : 23034 MISSION DR
Second Line :
City : CARSON
State : CA
Zip : 90745-4953
Country : US
Telephone Number : 310-816-9935
Fax Number :
Provider Business Practice Location Address
First Line : 23517 MAIN ST STE 103
Second Line :
City : CARSON
State : CA
Zip : 90745-5234
Country : US
Telephone Number : 310-834-5388
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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Directions to “ TERESA R MALONE ” Practice Location

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