Provider Demographics
NPI:1568635688
Name:AMORE, THERESA MAUREEN (LPT)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MAUREEN
Last Name:AMORE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:MAUREEN
Other - Last Name:AMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPT
Mailing Address - Street 1:2178 JOHNSON AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISBO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-781-4711
Mailing Address - Fax:209-460-0428
Practice Address - Street 1:1700 S EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-2000
Practice Address - Country:US
Practice Address - Phone:209-460-0429
Practice Address - Fax:209-460-0428
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician