Healthcare Provider Details

I. General information

NPI: 1548444144
Provider Name (Legal Business Name): TERRI HENRY, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44215 15TH ST W SUITE 203
LANCASTER CA
93534-4014
US

IV. Provider business mailing address

44215 15TH ST W SUITE 203
LANCASTER CA
93534-4014
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-0062
  • Fax: 661-949-5876
Mailing address:
  • Phone: 661-948-0062
  • Fax: 661-949-5876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69585
License Number StateCA

VIII. Authorized Official

Name: TERRI D HENRY
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 661-948-0062