Provider Demographics
NPI:1386079390
Name:PATRON, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PATRON
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 1:1025 SANDSPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-1724
Mailing Address - Country:US
Mailing Address - Phone:626-475-1210
Mailing Address - Fax:
Practice Address - Street 1:1025 SANDSPRINGS DR
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-1724
Practice Address - Country:US
Practice Address - Phone:626-475-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical