Healthcare Provider Details

I. General information

NPI: 1902964323
Provider Name (Legal Business Name): CRISTIANA FLORIANA TEODORESCU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRISTIANA FLORIANA TOHANEANU MD

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

PO BOX 503900
SAINT LOUIS MO
63150-3900
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5609
  • Fax: 314-268-4028
Mailing address:
  • Phone: 314-577-5609
  • Fax: 314-268-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2003011064
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: