Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A174005 | CA |
NPI | 1003348764 |
---|---|
Provider Name | Teresa Raya |
First Address | Charlotte, NC 28219-9305 |
Second Address | Huntington Park, CA 90255-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2017 |
Last Update Date | 12/02/2022 |