Provider Demographics
NPI:1669912986
Name:JAUREGUI, TERRY (LPT)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:
Last Name:JAUREGUI
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:JAUREGUI-ALVIAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:1908 VALLEY VIS
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7736
Mailing Address - Country:US
Mailing Address - Phone:805-878-9164
Mailing Address - Fax:
Practice Address - Street 1:1908 VALLET VISTA
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458
Practice Address - Country:US
Practice Address - Phone:805-878-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40008106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician