Healthcare Provider Details

I. General information

NPI: 1932922283
Provider Name (Legal Business Name): TERESA LYNN ALFORD PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRI LYNN ALFORD-MAYERS

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FAIRVIEW LN
SONORA CA
95370-4809
US

IV. Provider business mailing address

20848 SARATOGA RD
SONORA CA
95370-5423
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-2000
  • Fax:
Mailing address:
  • Phone: 209-352-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220283751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: