Provider Demographics
NPI:1518374776
Name:ROSEN, MARIA THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:THERESA
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA THERESA
Other - Middle Name:FERRER
Other - Last Name:BRECHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:72 WHITECAP ST
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2859
Mailing Address - Country:US
Mailing Address - Phone:805-264-2969
Mailing Address - Fax:805-295-6036
Practice Address - Street 1:72 WHITECAP ST
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2859
Practice Address - Country:US
Practice Address - Phone:805-264-2969
Practice Address - Fax:805-295-6036
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23497207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23497OtherCA MEDICAL LICENSE