Provider Demographics
NPI:1518448729
Name:DE MATEO, TERRYLYNE DASILAG
Entity Type:Individual
Prefix:
First Name:TERRYLYNE
Middle Name:DASILAG
Last Name:DE MATEO
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 1:70 BLUE BEAK WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5819
Mailing Address - Country:US
Mailing Address - Phone:808-419-1826
Mailing Address - Fax:
Practice Address - Street 1:2305 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5764
Practice Address - Country:US
Practice Address - Phone:702-357-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant