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General NPI Number Information
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NPI Number | 1336862325
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Entity Type | Individual
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Provider Name | TEONA CHILINDRISHVILI PA
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 1045 5TH ST
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City | LOS BANOS
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State | CA
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Zip | 93635-4204
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Country | US
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Telephone | 209-827-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 25 W I ST APT 22
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City | LOS BANOS
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State | CA
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Zip | 93635-3519
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Country | US
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Telephone | 314-366-2333
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0007481
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 61733
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License Number State | CA
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