Provider Demographics
NPI:1477706588
Name:TEEUWISSE, TATYANA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:MARIE
Last Name:TEEUWISSE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 LOS GATOS SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5317
Mailing Address - Country:US
Mailing Address - Phone:408-210-5584
Mailing Address - Fax:408-440-8876
Practice Address - Street 1:246 LOS GATOS SARATOGA RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5317
Practice Address - Country:US
Practice Address - Phone:408-210-5584
Practice Address - Fax:408-440-8876
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist