Provider Demographics
NPI:1891141081
Name:THERESA A. CYR, DO, MEDICAL CORPORATION
Entity Type:Organization
Organization Name:THERESA A. CYR, DO, MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CYR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:858-587-1822
Mailing Address - Street 1:3706 RUFFIN RD STE 129
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1812
Mailing Address - Country:US
Mailing Address - Phone:858-587-1822
Mailing Address - Fax:858-587-8967
Practice Address - Street 1:3706 RUFFIN RD STE 129
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1812
Practice Address - Country:US
Practice Address - Phone:858-587-1822
Practice Address - Fax:858-587-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty