Provider Demographics
NPI:1639618481
Name:TET TOE MD INC
Entity Type:Organization
Organization Name:TET TOE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-542-1458
Mailing Address - Street 1:1580 CREEKSIDE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3886
Mailing Address - Country:US
Mailing Address - Phone:916-542-1458
Mailing Address - Fax:916-542-1456
Practice Address - Street 1:1580 CREEKSIDE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3886
Practice Address - Country:US
Practice Address - Phone:916-542-1458
Practice Address - Fax:916-542-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105047261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care