Provider Demographics
NPI:1053482521
Name:TERESA P. AVANTS, M.D., INC.
Entity Type:Organization
Organization Name:TERESA P. AVANTS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:PFIEFLE
Authorized Official - Last Name:AVANTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-799-8620
Mailing Address - Street 1:25455 BARTON RD
Mailing Address - Street 2:SUITE A204
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3128
Mailing Address - Country:US
Mailing Address - Phone:909-799-8620
Mailing Address - Fax:909-799-1708
Practice Address - Street 1:25455 BARTON RD
Practice Address - Street 2:SUITE A204
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3128
Practice Address - Country:US
Practice Address - Phone:909-799-8620
Practice Address - Fax:909-799-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56066207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty