Healthcare Provider Details

I. General information

NPI: 1720997943
Provider Name (Legal Business Name): MRS. TERI MIHELCIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 LEIGH AVE
SAN JOSE CA
95124-5699
US

IV. Provider business mailing address

5210 LEIGH AVE
SAN JOSE CA
95124-5699
US

V. Phone/Fax

Practice location:
  • Phone: 408-626-3405
  • Fax:
Mailing address:
  • Phone: 408-626-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number220282796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: