Healthcare Provider Details

I. General information

NPI: 1487890455
Provider Name (Legal Business Name): TERRY DAVID MALTZ DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 WILDERNESS AVE
RIVERSIDE CA
92504-1014
US

IV. Provider business mailing address

5950 WILDERNESS AVE
RIVERSIDE CA
92504-1014
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-7387
  • Fax: 951-358-7920
Mailing address:
  • Phone: 951-358-7387
  • Fax: 951-358-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number4949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: