Provider Demographics
NPI:1942264072
Name:TERRAZAS, ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:TERRAZAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 BERRY ST STE 290
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1773
Mailing Address - Country:US
Mailing Address - Phone:415-353-1375
Mailing Address - Fax:415-353-4826
Practice Address - Street 1:185 BERRY STREET, SUITE 290
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-353-1375
Practice Address - Fax:415-353-4826
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80790207ZP0102X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Not Answered207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0G8079000Medicaid
CA0G8079000Medicaid
CA0G8079000Medicare PIN