Provider Demographics
NPI:1285256115
Name:VIDMAR, TERESA (RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:VIDMAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5065 MOUNT LA PLATTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3007
Mailing Address - Country:US
Mailing Address - Phone:530-219-7248
Mailing Address - Fax:
Practice Address - Street 1:2810 CRESTA LOMA
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-7778
Practice Address - Country:US
Practice Address - Phone:530-219-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80800163WC1500X
CA391318163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health