Healthcare Provider Details

I. General information

NPI: 1053939116
Provider Name (Legal Business Name): TEENA PERVAIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 COLUMBIA POINT DR STE 101
RICHLAND WA
99352-4390
US

IV. Provider business mailing address

112 COLUMBIA POINT DR STE 101
RICHLAND WA
99352-4390
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2023
  • Fax: 509-942-2640
Mailing address:
  • Phone: 509-942-2023
  • Fax: 509-942-2640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.70069082
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: