Provider Demographics
NPI:1679394555
Name:TERRY, AVERY (NERO DIAGNOSTICS)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:TERRY
Suffix:
Gender:M
Credentials:NERO DIAGNOSTICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39520 MURRIETA HOT SPRINGS RD STE 219
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7714
Mailing Address - Country:US
Mailing Address - Phone:619-818-5442
Mailing Address - Fax:
Practice Address - Street 1:39520 MURRIETA HOT SPRINGS RD STE 219
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7714
Practice Address - Country:US
Practice Address - Phone:619-818-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA994791940OtherLLC