MEDICARE: TERESA LAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1114869583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA LAM

Provider Business Mailing Address
First Line	:	23361 MADERO STE 176
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-2715
Country	:	US
Telephone Number	:	951-268-0489
Fax Number	:	714-849-5851

Provider Business Practice Location Address
First Line	:	23361 MADERO STE 176
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-2715
Country	:	US
Telephone Number	:	951-268-0489
Fax Number	:	714-849-5851

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ TERESA LAM ” Practice Location

Language	Start Address	Practice Location

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