Healthcare Provider Details

I. General information

NPI: 1205567583
Provider Name (Legal Business Name): MS. TERESA POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9080 IRVINE CENTER DR
IRVINE CA
92618-4658
US

IV. Provider business mailing address

PO BOX 808
CORONA DEL MAR CA
92625-0808
US

V. Phone/Fax

Practice location:
  • Phone: 949-216-8677
  • Fax: 949-776-5258
Mailing address:
  • Phone: 949-599-8398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number572390
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number572390
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: