Provider Demographics
NPI:1316668312
Name:TERESA, LINDSEY BLAIR
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:BLAIR
Last Name:TERESA
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 1:433 SALINAS ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2717
Mailing Address - Country:US
Mailing Address - Phone:831-757-7915
Mailing Address - Fax:831-757-0762
Practice Address - Street 1:433 SALINAS ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2717
Practice Address - Country:US
Practice Address - Phone:831-757-7915
Practice Address - Fax:831-757-0762
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program