Provider Demographics
NPI:1508347360
Name:PINE, TERESITA ESPERANZA
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:ESPERANZA
Last Name:PINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E GONZALES RD STE 102
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-8293
Mailing Address - Country:US
Mailing Address - Phone:805-981-5115
Mailing Address - Fax:805-981-5184
Practice Address - Street 1:2220 E GONZALES RD STE 102
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-8293
Practice Address - Country:US
Practice Address - Phone:805-981-5115
Practice Address - Fax:805-981-5184
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA653057163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management