Provider Demographics
NPI:1366553273
Name:NEENO, TERESA A (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:NEENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 J STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819
Mailing Address - Country:US
Mailing Address - Phone:916-453-8696
Mailing Address - Fax:916-453-8715
Practice Address - Street 1:5609 J STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-453-8696
Practice Address - Fax:916-453-8715
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK2338207K00000X
CAG150211207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD7090Medicaid
F95993Medicare UPIN
AK152351Medicare ID - Type Unspecified