Healthcare Provider Details

I. General information

NPI: 1225061922
Provider Name (Legal Business Name): MIRIAM E TEELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 JACKSON ST STE 206
RIVERSIDE CA
92503-3948
US

IV. Provider business mailing address

3975 JACKSON ST STE 206
RIVERSIDE CA
92503-3948
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-7920
  • Fax: 951-352-7908
Mailing address:
  • Phone: 951-977-9121
  • Fax: 951-977-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA2584
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1083
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU1083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: