Provider Demographics
NPI:1194479428
Name:TERIFAJ, SANDRA MAE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MAE
Last Name:TERIFAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11662 EVENING SKY DR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-2031
Mailing Address - Country:US
Mailing Address - Phone:714-319-5342
Mailing Address - Fax:
Practice Address - Street 1:11662 EVENING SKY DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-2031
Practice Address - Country:US
Practice Address - Phone:714-319-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT23231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist