Provider Demographics
NPI:1992799639
Name:TERAI ESCAMILLO, ANN AIKO (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:AIKO
Last Name:TERAI ESCAMILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:AIKO
Other - Last Name:TERAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1101 BALDWIN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5808
Mailing Address - Country:US
Mailing Address - Phone:626-851-6675
Mailing Address - Fax:
Practice Address - Street 1:315 E ROUTE 66
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6244
Practice Address - Country:US
Practice Address - Phone:626-963-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32856207V00000X
CAC55477207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
031881OtherMEDICARE
0331815OtherMEDICARE
AZ031813OtherMEDICARE
ZFQ31815OtherMEDICARE
AZ031814OtherMEDICARE
AZ031820OtherMEDICARE
0331815OtherMEDICARE
I18406Medicare UPIN
AZ031813OtherMEDICARE