Provider Demographics
NPI:1982639365
Name:CULLINS, ROSINA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSINA
Middle Name:MARIE
Last Name:CULLINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ROSINA
Other - Middle Name:MARIE
Other - Last Name:MONACO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5175 WARING RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2705
Mailing Address - Country:US
Mailing Address - Phone:619-583-1000
Mailing Address - Fax:619-229-1938
Practice Address - Street 1:5175 WARING RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2705
Practice Address - Country:US
Practice Address - Phone:619-583-1000
Practice Address - Fax:619-229-1938
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12360T152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP12360Medicare PIN
CA5776100001Medicare NSC