Provider Demographics
NPI:1871593970
Name:LARIOS-GILL, TERESA (FNP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:LARIOS-GILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:LARIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:741 S JUANITA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4357
Mailing Address - Country:US
Mailing Address - Phone:310-316-5696
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-226-2630
Practice Address - Fax:323-226-4316
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530702163W00000X
CA15162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily