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General NPI Number Information
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NPI Number | 1639618481
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Entity Type | Organization
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Legal Business Name | TET TOE MD INC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 1580 CREEKSIDE DR SUITE 130
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City | FOLSOM
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State | CA
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Zip | 95630-3886
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Country | US
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Telephone | 916-542-1458
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Fax | 916-542-1456
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Provider Business Mailing Address
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Address Line | 1580 CREEKSIDE DR SUITE 130
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City | FOLSOM
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State | CA
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Zip | 95630-3886
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Country | US
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Telephone | 916-542-1458
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Fax | 916-542-1456
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ANGELA GRAVES
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Credential | RN
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Telephone | 916-542-1458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A105047
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License Number State | CA
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