Provider Demographics
NPI:1740795426
Name:TERESA DUDAREWICZ MD, INC.
Entity Type:Organization
Organization Name:TERESA DUDAREWICZ MD, INC.
Other - Org Name:TERESA DUDAREWICZ MD, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDAREWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-442-0753
Mailing Address - Street 1:3937 SUMMER WAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-7942
Mailing Address - Country:US
Mailing Address - Phone:858-442-0753
Mailing Address - Fax:
Practice Address - Street 1:11440 W BERNARDO CT STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1644
Practice Address - Country:US
Practice Address - Phone:858-442-0753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty