Provider Demographics
NPI:1891167102
Name:TERRIQUEZ, OSWALDO
Entity Type:Individual
Prefix:
First Name:OSWALDO
Middle Name:
Last Name:TERRIQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 RANCHEROS DR STE 166
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2980
Mailing Address - Country:US
Mailing Address - Phone:760-744-3672
Mailing Address - Fax:
Practice Address - Street 1:340 RANCHEROS DR STE 166
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2980
Practice Address - Country:US
Practice Address - Phone:760-744-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACCAPP RADT-1101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor