Healthcare Provider Details

I. General information

NPI: 1366148082
Provider Name (Legal Business Name): TERI WEDECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15430 FOOTHILL BLVD
CASTRO VALLEY CA
94578-1009
US

IV. Provider business mailing address

160 E. VIRGINIA ST., SUITE 100
SAN JOSE CA
95112-5817
US

V. Phone/Fax

Practice location:
  • Phone: 510-357-3562
  • Fax:
Mailing address:
  • Phone: 408-938-2113
  • Fax: 408-579-6143

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 Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: