Provider Demographics
NPI:1235254848
Name:AVANTS, TERESA PFIEFLE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:PFIEFLE
Last Name:AVANTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25815 BARTON RD
Mailing Address - Street 2:SUITE C103
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3893
Mailing Address - Country:US
Mailing Address - Phone:909-799-8620
Mailing Address - Fax:909-799-1708
Practice Address - Street 1:25815 BARTON RD
Practice Address - Street 2:SUITE C103
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3893
Practice Address - Country:US
Practice Address - Phone:909-799-8620
Practice Address - Fax:909-799-1708
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56066207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E41928Medicare UPIN