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General NPI Number Information
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NPI Number | 1174900989
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Entity Type | Individual
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Provider Name | MELISSA ANN TEOLI PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 255 TERRACIHA BLVD SUITE 101A
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 909-748-6569
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Fax | 909-307-1231
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Provider Business Mailing Address
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Address Line | 19374 SOUTHAMPTON DR
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City | LIVONIA
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State | MI
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Zip | 48152-4106
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Country | US
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Telephone | 248-345-1654
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601007346
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License Number State | MI
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