Individual provider Active NPI

Teresita Santos Maqueda, M.D.

  • Internal Medicine Physician
  • Burbank, CA
National Provider Identifier
1932138013
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A48971 Issued in CA
Practice address
241 W Olive Ave
Burbank, CA 91502-1825
Phone
(818) 563-1400
Fax
(818) 563-4376
NPI assigned
Jul 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A48971 CA Primary

Addresses

Primary practice location

241 W Olive Ave
Burbank, CA 91502-1825

Mailing address

921 Calle la Primavera
Glendale, CA 91208-3030
Phone (818) 956-7115

Other identifiers 1

IdentifierTypeStateIssuer
00A489710MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100923000956 CA Practitioner - Internal Medicine 8820114101 Reassigns benefits to 1 organization
Practice locations: Burbank, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Tufts University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeside Medical Organization a Medical Group IncGroup PAC ID 7618005166, 64 clinicians

Practice addresses (Care Compare)

1500 S Central Ave
Suite 200
Glendale, CA 91204-3853
Phone (818) 291-4010

241 W Olive Ave
Burbank, CA 91502-1825
Phone (818) 563-1400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
48971CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health System - Southern California Past Accepting new patients
Lakeside Medical Associates, a Medical Group, Inc. Internal Medicine Past Accepting new patients
Lakeside Medical Associates, a Medical Group, Inc. Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1932138013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 CALLE LA PRIMAVERA",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912083030",
            "telephone_number": "818-956-7115",
            "fax_number": "818-956-7128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 W OLIVE AVE",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915021825",
            "telephone_number": "818-563-1400",
            "fax_number": "818-563-4376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAQUEDA",
        "first_name": "TERESITA",
        "middle_name": "SANTOS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A48971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A489710",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.