Provider Demographics
NPI:1194232686
Name:RADA, TERESA ANNE (NMD NATUROPATHIC PHY)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANNE
Last Name:RADA
Suffix:
Gender:F
Credentials:NMD NATUROPATHIC PHY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 POINT CIR
Mailing Address - Street 2:
Mailing Address - City:HAPPY JACK
Mailing Address - State:AZ
Mailing Address - Zip Code:86024-9746
Mailing Address - Country:US
Mailing Address - Phone:928-864-9108
Mailing Address - Fax:
Practice Address - Street 1:4665 POINT CIR
Practice Address - Street 2:
Practice Address - City:HAPPY JACK
Practice Address - State:AZ
Practice Address - Zip Code:86024-9746
Practice Address - Country:US
Practice Address - Phone:928-864-9108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-812175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath