Provider Demographics
NPI:1073295895
Name:SMITH, TEODORA
Entity Type:Individual
Prefix:
First Name:TEODORA
Middle Name:
Last Name:SMITH
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 1:2550 W UNION HILLS DR STE 350-3587
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5163
Mailing Address - Country:US
Mailing Address - Phone:480-744-1344
Mailing Address - Fax:
Practice Address - Street 1:2550 W UNION HILLS DR STE 350-3587
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5163
Practice Address - Country:US
Practice Address - Phone:480-744-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy