Provider Demographics
NPI:1609985308
Name:NAMBA BANSBACH, TERI (MD)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:NAMBA BANSBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:NAMBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7001
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-7001
Mailing Address - Country:US
Mailing Address - Phone:818-888-7815
Mailing Address - Fax:818-715-1722
Practice Address - Street 1:696 HAMPSHIRE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2699
Practice Address - Country:US
Practice Address - Phone:054-137-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55219207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology