Basic Information
| Provider Information | |||||||||
| NPI: | 1639103898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENAD | ||||||||
| FirstName: | TERESITA | ||||||||
| MiddleName: | SARGADILOS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 E YOSEMITE AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953408220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093849108 | ||||||||
| FaxNumber: | 2093840580 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 E YOSEMITE AVE STE A | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953408220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093849108 | ||||||||
| FaxNumber: | 2093840580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A496310 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A496310 | 05 | CA | MEDICAID |