Provider Demographics
NPI:1972651289
Name:TERRAZAS, MARIA ELENA (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:TERRAZAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3658
Mailing Address - Country:US
Mailing Address - Phone:909-882-4788
Mailing Address - Fax:909-882-8819
Practice Address - Street 1:190 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3658
Practice Address - Country:US
Practice Address - Phone:909-882-4788
Practice Address - Fax:909-882-8819
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 10694363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical