Healthcare Provider Details

I. General information

NPI: 1841397874
Provider Name (Legal Business Name): TEEDA M MARTOCCIA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11845 SOUTH ST
CERRITOS CA
90703-6825
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 562-809-8082
  • Fax:
Mailing address:
  • Phone: 714-347-1010
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: