Provider Demographics
NPI:1780280792
Name:MAGGIULLI, TESSA RHEA (DVM)
Entity type:Individual
Prefix:DR
First Name:TESSA
Middle Name:RHEA
Last Name:MAGGIULLI
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1240
Mailing Address - Country:US
Mailing Address - Phone:541-753-2223
Mailing Address - Fax:541-753-2278
Practice Address - Street 1:1562 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1240
Practice Address - Country:US
Practice Address - Phone:541-753-2223
Practice Address - Fax:541-753-2278
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7121208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice