Provider Demographics
NPI:1225061922
Name:TEELE, MIRIAM E
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:E
Last Name:TEELE
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 1:3975 JACKSON ST
Mailing Address - Street 2:STE 204
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3948
Mailing Address - Country:US
Mailing Address - Phone:951-977-9121
Mailing Address - Fax:951-977-9317
Practice Address - Street 1:3975 JACKSON ST
Practice Address - Street 2:STE 204
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-352-7920
Practice Address - Fax:951-352-7908
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2584237700000X
CAAU1083237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist