Provider Demographics
NPI:1881854990
Name:KORTZ, TERESA BLEAKLY (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:BLEAKLY
Last Name:KORTZ
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:TERESA
Other - Last Name:BLEAKLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UCSF DEPARTMENT OF PEDIATRICS, MAILCODE 0106
Mailing Address - Street 2:550 16TH STREET, 5TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-502-5825
Mailing Address - Fax:
Practice Address - Street 1:550 16TH ST FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2549
Practice Address - Country:US
Practice Address - Phone:415-502-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109795208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics