Provider Demographics
NPI:1497523203
Name:CERASIA, TERESA NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:NICOLE
Last Name:CERASIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:NICOLE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12304 SANTA MONICA BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2586
Mailing Address - Country:US
Mailing Address - Phone:310-820-8084
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 116
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2586
Practice Address - Country:US
Practice Address - Phone:310-820-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028241363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology