Healthcare Provider Details

I. General information

NPI: 1407022163
Provider Name (Legal Business Name): MARIA TERESA AMPUDIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W ROMNEYA DRIVE SUITE 203
ANAHEIM CA
92801
US

IV. Provider business mailing address

1801 W ROMNEYA DRIVE SUITE 203
ANAHEIM CA
92801
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-1465
  • Fax: 714-999-1701
Mailing address:
  • Phone: 714-999-1465
  • Fax: 714-999-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: