Healthcare Provider Details

I. General information

NPI: 1336862325
Provider Name (Legal Business Name): TEONA CHILINDRISHVILI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 MARKET PL STE 400
SAN RAMON CA
94583-4749
US

IV. Provider business mailing address

573 COUNTRYBROOK LOOP
SAN RAMON CA
94583-5301
US

V. Phone/Fax

Practice location:
  • Phone: 925-359-6173
  • Fax:
Mailing address:
  • Phone: 314-366-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: