Provider Demographics
NPI:1629356563
Name:FLORESCA, THERESA (OD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:FLORESCA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12494 BRICKELLIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4156
Mailing Address - Country:US
Mailing Address - Phone:858-837-4650
Mailing Address - Fax:
Practice Address - Street 1:2260 CALLAGAN HWY BLDG 3187
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-2222
Practice Address - Country:US
Practice Address - Phone:619-550-2679
Practice Address - Fax:619-664-4290
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14206152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist