MEDICARE: TERESA PRECIADO

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1598893463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA PRECIADO

Provider Business Mailing Address
First Line	:	100 BICENTENNIAL CIR APT 286
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-2879
Country	:	US
Telephone Number	:	559-736-5850
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 HARRIS AVE STE A
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95838-3249
Country	:	US
Telephone Number	:	916-649-6793
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	06/10/2014

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