Provider Demographics
NPI:1679037097
Name:TSENG, AUDREY MEGAN
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MEGAN
Last Name:TSENG
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 1:258 BRIDGEWATER RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-6651
Mailing Address - Country:US
Mailing Address - Phone:408-209-1258
Mailing Address - Fax:
Practice Address - Street 1:3532 MONROE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-6322
Practice Address - Country:US
Practice Address - Phone:408-209-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program