Healthcare Provider Details

I. General information

NPI: 1649834649
Provider Name (Legal Business Name): TERESSA R. JU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MARK WEST SPRINGS RD STE 310
SANTA ROSA CA
95403-1783
US

IV. Provider business mailing address

34 MARK WEST SPRINGS RD STE 310
SANTA ROSA CA
95403-1783
US

V. Phone/Fax

Practice location:
  • Phone: 707-573-5261
  • Fax:
Mailing address:
  • Phone: 707-573-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number13180950-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA208505
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number13180950-1205
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA208505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: