Provider Demographics
NPI:1790847838
Name:BENEZRA, TERESA LYNN (LAC,)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LYNN
Last Name:BENEZRA
Suffix:
Gender:F
Credentials:LAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 GEARY BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3109
Mailing Address - Country:US
Mailing Address - Phone:415-833-8730
Mailing Address - Fax:
Practice Address - Street 1:4141 GEARY BLVD
Practice Address - Street 2:212
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3109
Practice Address - Country:US
Practice Address - Phone:415-833-8730
Practice Address - Fax:415-833-4781
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4241171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist