Provider Demographics
NPI:1740899822
Name:AVORH, THERESA W (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:W
Last Name:AVORH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:W
Other - Last Name:ADU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:3851 ROSECRANS STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3134
Mailing Address - Country:US
Mailing Address - Phone:619-531-5800
Mailing Address - Fax:619-542-4186
Practice Address - Street 1:3851 ROSECRANS STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3134
Practice Address - Country:US
Practice Address - Phone:619-531-5800
Practice Address - Fax:619-542-4186
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630123163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse