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NPI Code Detail

MEDICARE: AUDREY ANDERSON TESHIMA MFT INTERN

MEDICARE: AUDREY ANDERSON TESHIMA MFT INTERN
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
1106H00000XMarriage & Family Therapist107465CA

General Provider Information

NPI Number : 1942559695
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY ANDERSON TESHIMA MFT INTERN
Provider Business Mailing Address
First Line : 1045 9TH AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-5504
Country : US
Telephone Number : 858-449-1059
Fax Number :
Provider Business Practice Location Address
First Line : 1045 9TH AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-5504
Country : US
Telephone Number : 858-449-1059
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2012
Last Update Date : 01/22/2024

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Directions to “ AUDREY ANDERSON TESHIMA MFT INTERN” Practice Location

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