Provider Demographics
NPI:1033596796
Name:TEVES, DONOVAN GARCIA
Entity Type:Individual
Prefix:MR
First Name:DONOVAN
Middle Name:GARCIA
Last Name:TEVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 LAKEVIEW AVE.
Mailing Address - Street 2:SUITE 'A'
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-779-8544
Mailing Address - Fax:
Practice Address - Street 1:1261 LAKEVIEW AVE.
Practice Address - Street 2:SUITE 'A'
Practice Address - City:ANAHEIM HILLS
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:714-779-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist