Provider Demographics
NPI:1427011709
Name:ROSSI-FOULKES, RITA
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:ROSSI-FOULKES
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 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8723 ALDEN DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3692
Practice Address - Country:US
Practice Address - Phone:310-423-2811
Practice Address - Fax:310-423-7485
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086978207R00000X
CAG87096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF76062Medicare UPIN
ILL69171Medicare ID - Type Unspecified