Provider Demographics
NPI:1588249304
Name:MIHALYI, THERESA R
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:R
Last Name:MIHALYI
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 1:617 MCDEVITT DR
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95692-9773
Mailing Address - Country:US
Mailing Address - Phone:916-251-6383
Mailing Address - Fax:
Practice Address - Street 1:617 MCDEVITT DR
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:CA
Practice Address - Zip Code:95692-9773
Practice Address - Country:US
Practice Address - Phone:916-251-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANAOtherCARE GIVER