Provider Demographics
NPI:1124808647
Name:MCGOVERN, TERENCE
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 PALOS VERDES DR N STE 100
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2529
Mailing Address - Country:US
Mailing Address - Phone:310-377-3776
Mailing Address - Fax:310-377-3779
Practice Address - Street 1:4000 PALOS VERDES DR N STE 100
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2529
Practice Address - Country:US
Practice Address - Phone:310-377-3776
Practice Address - Fax:310-377-3779
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide