Provider Demographics
NPI:1336316504
Name:TEODORO, AMI CHIRSTINE (MLP-PA)
Entity Type:Individual
Prefix:PROF
First Name:AMI
Middle Name:CHIRSTINE
Last Name:TEODORO
Suffix:
Gender:F
Credentials:MLP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6527
Mailing Address - Country:US
Mailing Address - Phone:916-437-0570
Mailing Address - Fax:916-437-0470
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3238
Practice Address - Fax:510-601-3904
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19708363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19708OtherPAC LICENSE