Provider Demographics
NPI:1518901354
Name:ROCK, TERRI L (MD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:ROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2021 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 335 EAST
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2208
Mailing Address - Country:US
Mailing Address - Phone:310-829-7625
Mailing Address - Fax:310-319-2468
Practice Address - Street 1:2021 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 335 EAST
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2208
Practice Address - Country:US
Practice Address - Phone:310-829-7625
Practice Address - Fax:310-319-2468
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA048669207QA0505X
TXG8961207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A486690Medicaid
CA00A486690Medicaid
CAA48669Medicare PIN