Provider Demographics
NPI:1649450016
Name:MALONEY, THERESA DENISE (FNP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:DENISE
Last Name:MALONEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:TESS
Other - Middle Name:
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:STE 2100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5238
Mailing Address - Country:US
Mailing Address - Phone:619-229-3929
Mailing Address - Fax:619-229-3902
Practice Address - Street 1:1945 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3595
Practice Address - Country:US
Practice Address - Phone:858-224-7977
Practice Address - Fax:858-224-7978
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WNP10743AMedicare PIN
S96658Medicare UPIN