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General NPI Number Information
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NPI Number | 1932138013
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Entity Type | Individual
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Provider Name | TERESITA SANTOS MAQUEDA M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 241 W OLIVE AVE
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City | BURBANK
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State | CA
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Zip | 91502-1825
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Country | US
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Telephone | 818-563-1400
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Fax | 818-563-4376
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Provider Business Mailing Address
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Address Line | 921 CALLE LA PRIMAVERA
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City | GLENDALE
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State | CA
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Zip | 91208-3030
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Country | US
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Telephone | 818-956-7115
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Fax | 818-956-7128
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A48971
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License Number State | CA
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