Basic Information
| Provider Information | |||||||||
| NPI: | 1538233572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERUYA | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11370 ANDERSON ST | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095582126 | ||||||||
| FaxNumber: | 9095582401 | ||||||||
| Practice Location | |||||||||
| Address1: | 11370 ANDERSON ST | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095582126 | ||||||||
| FaxNumber: | 9095582401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 10795 | HI | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 10795 | HI | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | A71912 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 517420 | 01 | HMA NEW | OTHER | 990287995 | 01 | HMA | OTHER | 990287995 | 01 | VET ADMIN | OTHER | 990287995 | 01 | UHA | OTHER | 990287995 | 01 | CYRCA | OTHER | MD10795 | 01 | MDX | OTHER | 0000249011 | 01 | HMSA | OTHER | 55759801 | 05 | HI | MEDICAID | 55759801 | 01 | ALOHACARE | OTHER | 990287995 | 01 | DMBA | OTHER | 990287995 | 01 | HMAA | OTHER | 990287995 | 01 | TRICARE | OTHER | 990287995 | 01 | AETNA | OTHER | 990287995 | 01 | HPMR | OTHER | 990287995 | 01 | PAC ADMIN | OTHER | 990287995 | 01 | UHC | OTHER |