MEDICARE: TEO DRAGIC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1841139839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEO DRAGIC

Provider Business Mailing Address
First Line	:	3843 W BERYL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-1137
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3843 W BERYL AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-1137
Country	:	US
Telephone Number	:	602-692-0825
Fax Number	:

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

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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Directions to “ TEO DRAGIC ” Practice Location

Language	Start Address	Practice Location

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