MEDICARE: TERESA EILEEN NORTH P.A.-C

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	363A00000X	Physician Assistant	PA 10502	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568460731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA EILEEN NORTH P.A.-C

Provider Business Mailing Address
First Line	:	5301 F ST
Second Line	:	STE 111
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3226
Country	:	US
Telephone Number	:	916-452-8291
Fax Number	:	916-452-1733

Provider Business Practice Location Address
First Line	:	5301 F ST
Second Line	:	STE 111
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3226
Country	:	US
Telephone Number	:	916-452-8291
Fax Number	:	916-452-1733

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/07/2014

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