Provider Demographics
NPI:1346862406
Name:TERESA LOERA LLC
Entity Type:Organization
Organization Name:TERESA LOERA LLC
Other - Org Name:TL FAMILY NURSE PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-652-9802
Mailing Address - Street 1:4150 W PEORIA AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3951
Mailing Address - Country:US
Mailing Address - Phone:602-918-3225
Mailing Address - Fax:
Practice Address - Street 1:4150 W PEORIA AVE STE 122
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3951
Practice Address - Country:US
Practice Address - Phone:602-918-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty