Provider Demographics
NPI:1912195280
Name:RABANAL, TERESA C
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:C
Last Name:RABANAL
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 1:1437 SILVER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1567
Mailing Address - Country:US
Mailing Address - Phone:619-216-3092
Mailing Address - Fax:619-216-3092
Practice Address - Street 1:7733 PALM ST STE 107
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2967
Practice Address - Country:US
Practice Address - Phone:619-460-1991
Practice Address - Fax:619-460-1995
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice