Provider Demographics
NPI:1447313317
Name:TEYBER, EDWARD CHARLES
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CHARLES
Last Name:TEYBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 S AUTO PLAZA DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2762
Mailing Address - Country:US
Mailing Address - Phone:909-885-4545
Mailing Address - Fax:909-621-6900
Practice Address - Street 1:1325 S AUTO PLAZA DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2762
Practice Address - Country:US
Practice Address - Phone:909-885-4545
Practice Address - Fax:909-621-6900
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical