Provider Demographics
NPI:1487890455
Name:MALTZ, TERRY DAVID (DVM)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DAVID
Last Name:MALTZ
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 WILDERNESS AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1014
Mailing Address - Country:US
Mailing Address - Phone:951-358-7387
Mailing Address - Fax:951-358-7920
Practice Address - Street 1:5950 WILDERNESS AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1014
Practice Address - Country:US
Practice Address - Phone:951-358-7387
Practice Address - Fax:951-358-7920
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4949174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian