Provider Demographics
NPI:1659320497
Name:TWEED, ROSEMARIE (DO)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:TWEED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14114 BUSINESS CENTER DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553
Mailing Address - Country:US
Mailing Address - Phone:951-697-4133
Mailing Address - Fax:951-697-4130
Practice Address - Street 1:14114 BUSINESS CENTER DRIVE
Practice Address - Street 2:STE A
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553
Practice Address - Country:US
Practice Address - Phone:951-697-4133
Practice Address - Fax:951-697-4130
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5397208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX53971Medicaid