Provider Demographics
NPI:1053335455
Name:QUIMSON-CRUZ, ROSEMARIE ROQUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:ROQUE
Last Name:QUIMSON-CRUZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROSEMARIE
Other - Middle Name:ROQUE
Other - Last Name:QUIMSON-CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2252 BEVERLY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2225
Mailing Address - Country:US
Mailing Address - Phone:213-387-6453
Mailing Address - Fax:213-387-5390
Practice Address - Street 1:2252 BEVERLY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2225
Practice Address - Country:US
Practice Address - Phone:213-387-6453
Practice Address - Fax:213-387-5390
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice