Provider Demographics
NPI:1407464787
Name:CORIELL, TERESA BUSTOS (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:BUSTOS
Last Name:CORIELL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 S MILLIKEN AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-2336
Mailing Address - Country:US
Mailing Address - Phone:909-983-2020
Mailing Address - Fax:909-988-4571
Practice Address - Street 1:1420 S MILLIKEN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2336
Practice Address - Country:US
Practice Address - Phone:909-983-2020
Practice Address - Fax:909-988-4571
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314157163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health