MEDICARE: RAFAEL ROMAN TERAN F.N.P.

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	163WG0000X	General Practice Registered Nurse	20891	CA
2	364SF0001X	Family Health Clinical Nurse Specialist	20891	CA
3	363LF0000X	Family Nurse Practitioner	NP20891	CA

General Provider Information

NPI Number	:	1487939989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL ROMAN TERAN F.N.P.

Provider Business Mailing Address
First Line	:	2576 S DUKE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-8831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2576 S DUKE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-8831
Country	:	US
Telephone Number	:	559-123-4567
Fax Number	:

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

Provider Enumeration Date	:	10/15/2011
Last Update Date	:	02/26/2015

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