Provider Demographics
NPI:1275649642
Name:CARMEN TERREROS MD INC
Entity Type:Organization
Organization Name:CARMEN TERREROS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TERREROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-541-4145
Mailing Address - Street 1:801 N TUSTIN
Mailing Address - Street 2:SUITE 607
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3610
Mailing Address - Country:US
Mailing Address - Phone:714-541-4145
Mailing Address - Fax:714-541-5862
Practice Address - Street 1:801 NORTH TUSTIN AVENUE
Practice Address - Street 2:SUITE 607
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3610
Practice Address - Country:US
Practice Address - Phone:714-541-4145
Practice Address - Fax:714-541-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31148Medicare UPIN
CAW18522Medicare ID - Type Unspecified