Provider Demographics
NPI:1679634406
Name:DUDAREWICZ, TERESA (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DUDAREWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5138
Mailing Address - Country:US
Mailing Address - Phone:858-729-0034
Mailing Address - Fax:858-729-0319
Practice Address - Street 1:7300 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5138
Practice Address - Country:US
Practice Address - Phone:858-729-0034
Practice Address - Fax:858-729-0319
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA65431Medicare ID - Type Unspecified
CAG72899Medicare UPIN