Healthcare Provider Details

I. General information

NPI: 1669685293
Provider Name (Legal Business Name): TERI LYNN RHETTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 6TH ST
RANCHO CUCAMONGA CA
91730-5977
US

IV. Provider business mailing address

11234 ANDERSON ST #CP 21005- HOUSE STAFF OFFICE
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 951-335-3769
  • Fax: 909-890-5538
Mailing address:
  • Phone: 909-558-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA93663
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA93663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: