Healthcare Provider Details

I. General information

NPI: 1174197461
Provider Name (Legal Business Name): MARIA REGINA TEODORO TEMPORAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 TELEGRAPH AVE
BERKELEY CA
94705-1166
US

IV. Provider business mailing address

5248 CLAREMONT AVE APT 27A
OAKLAND CA
94618-1066
US

V. Phone/Fax

Practice location:
  • Phone: 510-495-0131
  • Fax:
Mailing address:
  • Phone: 707-342-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW128551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: