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General NPI Number Information
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NPI Number | 1174197461
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Entity Type | Individual
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Provider Name | MARIA REGINA TEODORO TEMPORAL
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Gender | Female
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 2809 TELEGRAPH AVE
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City | BERKELEY
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State | CA
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Zip | 94705-1166
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Country | US
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Telephone | 510-495-0131
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Fax |
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Provider Business Mailing Address
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Address Line | 5248 CLAREMONT AVE APT 27A
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City | OAKLAND
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State | CA
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Zip | 94618-1066
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Country | US
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Telephone | 707-342-8721
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW128551
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License Number State | CA
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