Provider Demographics
NPI:1346413655
Name:HU, TERESA DIWATA (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:DIWATA
Last Name:HU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:DELEON
Other - Last Name:DIWATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9732 WILD TEAK CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8380
Mailing Address - Country:US
Mailing Address - Phone:916-690-8299
Mailing Address - Fax:
Practice Address - Street 1:7700 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2608
Practice Address - Country:US
Practice Address - Phone:916-386-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN450458273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit