Provider Demographics
NPI:1851314520
Name:ROSALES, TERESA O (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:O
Last Name:ROSALES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4100 LONG BEACH BLVD
Mailing Address - Street 2:#108
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2696
Mailing Address - Country:US
Mailing Address - Phone:562-426-3925
Mailing Address - Fax:562-595-7639
Practice Address - Street 1:4100 LONG BEACH BLVD
Practice Address - Street 2:#108
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2696
Practice Address - Country:US
Practice Address - Phone:562-426-3925
Practice Address - Fax:562-595-7639
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG34354207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A45893Medicare UPIN
CAA45893Medicare UPIN