Provider Demographics
NPI:1225230485
Name:CHENTANEZ, TEERA (MD)
Entity Type:Individual
Prefix:
First Name:TEERA
Middle Name:
Last Name:CHENTANEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 COUNTRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-7319
Mailing Address - Country:US
Mailing Address - Phone:925-418-0282
Mailing Address - Fax:925-978-0991
Practice Address - Street 1:400 TAYLOR BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2147
Practice Address - Country:US
Practice Address - Phone:925-687-2570
Practice Address - Fax:925-687-2847
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016017551207RI0200X
KS04-35026207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002119OtherMEDICARE PTAN
KS200727320AMedicaid