Provider Demographics
NPI:1639103898
Name:ENAD, TERESITA SARGADILOS (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:SARGADILOS
Last Name:ENAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E YOSEMITE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8220
Mailing Address - Country:US
Mailing Address - Phone:209-384-9108
Mailing Address - Fax:209-384-0580
Practice Address - Street 1:410 E YOSEMITE AVE STE A
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8220
Practice Address - Country:US
Practice Address - Phone:209-384-9108
Practice Address - Fax:209-384-0580
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA496310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A496310Medicaid
CA00A496310Medicare ID - Type Unspecified
CA00A496310Medicaid