Provider Demographics
NPI:1871922450
Name:RETODO, EDROSE PEREZ (NP)
Entity type:Individual
Prefix:MRS
First Name:EDROSE
Middle Name:PEREZ
Last Name:RETODO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24301 SOUTHLAND DRIVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542
Mailing Address - Country:US
Mailing Address - Phone:510-781-0211
Mailing Address - Fax:510-781-0945
Practice Address - Street 1:24301 SOUTHLAND DRIVE
Practice Address - Street 2:SUITE 213
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542
Practice Address - Country:US
Practice Address - Phone:510-781-0211
Practice Address - Fax:510-781-0945
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP23308363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner