Provider Demographics
NPI:1285820985
Name:PRASLIN, TEOBALDO (PA-C)
Entity Type:Individual
Prefix:
First Name:TEOBALDO
Middle Name:
Last Name:PRASLIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1708
Mailing Address - Country:US
Mailing Address - Phone:323-265-3060
Mailing Address - Fax:323-266-8300
Practice Address - Street 1:3410 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1708
Practice Address - Country:US
Practice Address - Phone:323-265-3060
Practice Address - Fax:323-266-8300
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16899363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical