Provider Demographics
NPI:1912550179
Name:TERRY, DESTINY F
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:F
Last Name:TERRY
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 1:1150 E SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-4508
Mailing Address - Country:US
Mailing Address - Phone:559-556-0030
Mailing Address - Fax:
Practice Address - Street 1:1150 E SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4508
Practice Address - Country:US
Practice Address - Phone:559-556-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other