Provider Demographics
NPI:1558953299
Name:QUE, ROSITA TAN (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:MRS
First Name:ROSITA
Middle Name:TAN
Last Name:QUE
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:MRS
Other - First Name:ROSITA
Other - Middle Name:QUE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 LA TERRAZA BLVD. SUITE 130
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3876
Mailing Address - Country:US
Mailing Address - Phone:760-737-2050
Mailing Address - Fax:760-796-3788
Practice Address - Street 1:500 LA TERRAZA BLVD. SUITE 130
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3876
Practice Address - Country:US
Practice Address - Phone:760-737-2050
Practice Address - Fax:760-796-3788
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily