Provider Demographics
NPI:1982811386
Name:TEC, ELIZABETH (PPS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:TEC
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3454 DEL SOL BLVD APT L
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-3507
Mailing Address - Country:US
Mailing Address - Phone:619-690-3624
Mailing Address - Fax:
Practice Address - Street 1:4350 OTAY MESA RD
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-1617
Practice Address - Country:US
Practice Address - Phone:619-428-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool