Provider Demographics
NPI:1144803313
Name:TEIXEIRA, ROSEMARIE ATHENA
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:ATHENA
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N 2ND ST APT 311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2015
Mailing Address - Country:US
Mailing Address - Phone:781-591-9668
Mailing Address - Fax:
Practice Address - Street 1:3400 CALIFORNIA ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1863
Practice Address - Country:US
Practice Address - Phone:415-567-2408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108019122300000X
390200000X
PADS044384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program