Provider Demographics
NPI:1831433101
Name:FERRARO, THERESA MARIE (DOM)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:FERRARO
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31783
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-1783
Mailing Address - Country:US
Mailing Address - Phone:505-501-3376
Mailing Address - Fax:
Practice Address - Street 1:1532 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3512
Practice Address - Country:US
Practice Address - Phone:505-986-9109
Practice Address - Fax:505-989-3221
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM841171100000X
MT181171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist