Provider Demographics
NPI:1215220710
Name:BUENROSTRO, TERESITA (RD)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:
Last Name:BUENROSTRO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 N FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4118
Mailing Address - Country:US
Mailing Address - Phone:323-240-4903
Mailing Address - Fax:323-240-4903
Practice Address - Street 1:28 E NEWMAN AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2834
Practice Address - Country:US
Practice Address - Phone:323-240-4903
Practice Address - Fax:323-240-4903
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA894639133VN1006X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic