Provider Demographics
NPI:1376135673
Name:TEODORO, EDUARDO B JR (BSN)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:B
Last Name:TEODORO
Suffix:JR
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 GLEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103
Mailing Address - Country:US
Mailing Address - Phone:626-491-9055
Mailing Address - Fax:
Practice Address - Street 1:210 W SAN BERNANDINO ROAD
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723
Practice Address - Country:US
Practice Address - Phone:626-938-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95123692163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health