Provider Demographics
NPI:1194735753
Name:DIAZ, TERESA LYNN (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:RATTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1411 E 31ST STREET
Mailing Address - Street 2:OAKCARE MEDICAL GROUP
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1080
Mailing Address - Country:US
Mailing Address - Phone:510-437-4323
Mailing Address - Fax:510-437-5042
Practice Address - Street 1:1411 E 31ST STREET
Practice Address - Street 2:OAKCARE MEDICAL GROUP
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1080
Practice Address - Country:US
Practice Address - Phone:510-437-4323
Practice Address - Fax:510-437-5042
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88588207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A885880Medicaid
CA00A885880Medicare ID - Type Unspecified
CA00A885880Medicaid