Healthcare Provider Details

I. General information

NPI: 1245224831
Provider Name (Legal Business Name): TERESA ROZON BONDOC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA VITERBO ROZON-BONDOC MD

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N BELLFLOWER BLVD SUITE # 115
LONG BEACH CA
90815-1129
US

IV. Provider business mailing address

2700 N BELLFLOWER BLVD SUITE # 115
LONG BEACH CA
90815-1129
US

V. Phone/Fax

Practice location:
  • Phone: 562-425-1275
  • Fax: 562-982-0173
Mailing address:
  • Phone: 562-425-1275
  • Fax: 562-982-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA49027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: