Provider Demographics
NPI:1790117604
Name:AMPIE, TERESITA J
Entity Type:Individual
Prefix:MS
First Name:TERESITA
Middle Name:J
Last Name:AMPIE
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 1:533 CLARINADA AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4095
Mailing Address - Country:US
Mailing Address - Phone:415-206-3377
Mailing Address - Fax:
Practice Address - Street 1:533 CLARINADA AVE APT 10
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4095
Practice Address - Country:US
Practice Address - Phone:415-206-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty