Provider Demographics
NPI:1245364728
Name:ROSALES, TERESA B (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:B
Last Name:ROSALES
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 1:1800 NORTH 16TH ST.
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632
Mailing Address - Country:US
Mailing Address - Phone:712-542-6105
Mailing Address - Fax:
Practice Address - Street 1:1800 NORTH 16TH ST.
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632
Practice Address - Country:US
Practice Address - Phone:712-542-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA274492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology