Provider Demographics
NPI:1063534964
Name:GOLTIAO, TEODORA A (PSYCH TECHNICIAN)
Entity type:Individual
Prefix:MS
First Name:TEODORA
Middle Name:A
Last Name:GOLTIAO
Suffix:
Gender:F
Credentials:PSYCH TECHNICIAN
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Mailing Address - Street 1:2001 THE ALAMEDA
Mailing Address - Street 2:ALLIANCE FOR COMMUNITY CARE
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1136
Mailing Address - Country:US
Mailing Address - Phone:408-261-7777
Mailing Address - Fax:408-254-9960
Practice Address - Street 1:438 N WHITE RD
Practice Address - Street 2:ALLIANCE FOR COMMUNITY CARE SERVICE TEAM ADULT OUTPATI
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-1439
Practice Address - Country:US
Practice Address - Phone:408-254-6828
Practice Address - Fax:408-254-6838
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT27607167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician