Provider Demographics
NPI:1972896736
Name:TEOFILO, MARIA CRISTINA SALAK
Entity Type:Individual
Prefix:MRS
First Name:MARIA CRISTINA
Middle Name:SALAK
Last Name:TEOFILO
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 1:21055 PASEO VEREDA
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2120
Mailing Address - Country:US
Mailing Address - Phone:949-419-4888
Mailing Address - Fax:
Practice Address - Street 1:21055 PASEO VEREDA
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2120
Practice Address - Country:US
Practice Address - Phone:949-419-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694274163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse