1487655304 NPI number — MRS. CYNTHIA ESGUERRA TEH M.D.

Table of content: MRS. CYNTHIA ESGUERRA TEH M.D. (NPI 1487655304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487655304 NPI number — MRS. CYNTHIA ESGUERRA TEH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESGUERRA TEH
Provider First Name:
CYNTHIA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESGUERRA
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487655304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 PROFESSIONAL COURT
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128-0839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-240-8155
Provider Business Mailing Address Fax Number:
702-240-8161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 PROFESSIONAL COURT
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-0839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-240-8155
Provider Business Practice Location Address Fax Number:
702-240-8161
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  8375 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2019309 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002019309 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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