Provider Demographics
NPI:1558501999
Name:FARAG, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:FARAG
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 1:22855 BALTAR ST
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3602
Mailing Address - Country:US
Mailing Address - Phone:818-274-7478
Mailing Address - Fax:
Practice Address - Street 1:8660 WOODLEY AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5745
Practice Address - Country:US
Practice Address - Phone:818-894-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant