Provider Demographics
NPI:1417185216
Name:ZAMARY, TERESA (DO)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ZAMARY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:ISHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:360 EVERETT AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:KAISER DERMATOLOGY - MAPLE BUILDING
Practice Address - Street 2:910 MAPLE STREET
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-299-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A11447207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program