=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497801062
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRY JAY WARSAW M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 02/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20211 W VALLEY BLVD
-----------------------------------------------------
City | TEHACHAPI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93561-6748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-822-5544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20211 W VALLEY BLVD
-----------------------------------------------------
City | TEHACHAPI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93561-6748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-822-5544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G35426
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------