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General NPI Number Information
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NPI Number | 1205497658
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Entity Type | Individual
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Provider Name | TERESA MAY BOURGO ASW
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Gender | Female
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 1300 AVENIDA VISTA HERMOSA STE 250
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6340
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Country | US
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Telephone | 949-240-2272
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Fax |
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Provider Business Mailing Address
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Address Line | 31706 COAST HWY UNIT 401
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-7022
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Country | US
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Telephone | 949-973-5578
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW131993
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License Number State | CA
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