Provider Demographics
NPI:1922443373
Name:TOSTADO, TERESA AVENDANO (NP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:AVENDANO
Last Name:TOSTADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1825
Mailing Address - Country:US
Mailing Address - Phone:626-593-5993
Mailing Address - Fax:888-444-9401
Practice Address - Street 1:956 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1825
Practice Address - Country:US
Practice Address - Phone:626-593-5993
Practice Address - Fax:888-444-9401
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily