Healthcare Provider Details

I. General information

NPI: 1528860566
Provider Name (Legal Business Name): TERESA NOELLE ROKOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST GNH 1060K
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1380 DOREMUS RD
PASADENA CA
91105-2741
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-7053
  • Fax:
Mailing address:
  • Phone: 626-529-4846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: