Healthcare Provider Details

I. General information

NPI: 1033033931
Provider Name (Legal Business Name): TEODORA DILLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17449 MATINAL RD
SAN DIEGO CA
92127-1299
US

IV. Provider business mailing address

17449 MATINAL RD
SAN DIEGO CA
92127-1299
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-2026
  • Fax: 858-673-9103
Mailing address:
  • Phone: 858-487-2026
  • Fax: 858-673-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number19362
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: