Healthcare Provider Details

I. General information

NPI: 1417097569
Provider Name (Legal Business Name): TERESA TO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CASTRO ST SUITE 150
MOUNTAIN VIEW CA
94041-2055
US

IV. Provider business mailing address

650 CASTRO ST SUITE 150
MOUNTAIN VIEW CA
94041-2055
US

V. Phone/Fax

Practice location:
  • Phone: 650-965-3937
  • Fax: 650-965-1221
Mailing address:
  • Phone: 650-965-3937
  • Fax: 650-965-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: