Provider Demographics
NPI:1235263773
Name:TEIJEIRO, ANNETTE (M D)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:TEIJEIRO
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93953
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-3953
Mailing Address - Country:US
Mailing Address - Phone:702-837-3538
Mailing Address - Fax:702-263-3338
Practice Address - Street 1:174 ULTRA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8331
Practice Address - Country:US
Practice Address - Phone:702-837-3538
Practice Address - Fax:702-263-3338
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6699207L00000X
WAMD00030492207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019249Medicaid
NV2019249Medicaid
F60064Medicare UPIN