Healthcare Provider Details

I. General information

NPI: 1124728480
Provider Name (Legal Business Name): TERESA LENA RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16467 MURPHY AVE
IRVINE CA
92606-1794
US

IV. Provider business mailing address

16467 MURPHY AVE
IRVINE CA
92606-1794
US

V. Phone/Fax

Practice location:
  • Phone: 714-655-8190
  • Fax:
Mailing address:
  • Phone: 714-655-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95072412
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number95072412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: