Healthcare Provider Details

I. General information

NPI: 1811366990
Provider Name (Legal Business Name): TERRI OBERTO CNC CPT PHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CURTIS ST
SANTA CRUZ CA
95060-2911
US

IV. Provider business mailing address

120 CURTIS ST
SANTA CRUZ CA
95060-2911
US

V. Phone/Fax

Practice location:
  • Phone: 831-588-8126
  • Fax:
Mailing address:
  • Phone: 831-588-8126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: