Provider Demographics
NPI:1477634020
Name:ZARENO, TERESITA A (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:A
Last Name:ZARENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2410
Mailing Address - Country:US
Mailing Address - Phone:213-386-5252
Mailing Address - Fax:213-386-5323
Practice Address - Street 1:1600 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2410
Practice Address - Country:US
Practice Address - Phone:213-386-5252
Practice Address - Fax:213-386-5323
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082120Medicaid
CAGR0082120Medicaid
CAW14418Medicare ID - Type Unspecified