Provider Demographics
NPI:1669570008
Name:JOSEPH TERRAZZINO M D INC
Entity type:Organization
Organization Name:JOSEPH TERRAZZINO M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRAZZINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-254-0172
Mailing Address - Street 1:P.O. BOX 55115
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91385-0115
Mailing Address - Country:US
Mailing Address - Phone:661-254-0172
Mailing Address - Fax:661-254-0017
Practice Address - Street 1:23823 VALENCIA BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2103
Practice Address - Country:US
Practice Address - Phone:661-254-0172
Practice Address - Fax:661-254-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75356207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE76675Medicare UPIN
CAW20160Medicare PIN