Healthcare Provider Details

I. General information

NPI: 1265627947
Provider Name (Legal Business Name): TERESITA M AMAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 12/14/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 NW 2ND AVE
VISALIA CA
93291-3672
US

IV. Provider business mailing address

109 NW 2ND AVE
VISALIA CA
93291-3672
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-1490
  • Fax: 556-737-4318
Mailing address:
  • Phone: 559-627-1490
  • Fax: 556-737-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA100976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: