Basic Information
| Provider Information | |||||||||
| NPI: | 1376135673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEODORO | ||||||||
| FirstName: | EDUARDO | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1658 GLEN AVENUE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264919055 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 210 W SAN BERNANDINO ROAD | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269387650 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2021 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN95123692 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.