Provider Demographics
NPI:1285964130
Name:TEODOSIO, ARTHUR RAY JR (RW2447)
Entity type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:RAY
Last Name:TEODOSIO
Suffix:JR
Gender:M
Credentials:RW2447
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 FRIARS RD.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:858-668-2990
Mailing Address - Fax:
Practice Address - Street 1:7020 FRIARS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1126
Practice Address - Country:US
Practice Address - Phone:619-718-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP2500X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)