Provider Demographics
NPI:1992124267
Name:PREJILLANA, TERESITA
Entity type:Individual
Prefix:
First Name:TERESITA
Middle Name:
Last Name:PREJILLANA
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 1:2525 COLORADO BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1062
Mailing Address - Country:US
Mailing Address - Phone:323-739-0333
Mailing Address - Fax:323-739-0330
Practice Address - Street 1:2525 COLORADO BLVD STE D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1062
Practice Address - Country:US
Practice Address - Phone:323-739-0333
Practice Address - Fax:323-739-0330
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511410163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse