Healthcare Provider Details

I. General information

NPI: 1043548985
Provider Name (Legal Business Name): ROSEMARIE TWEED, D.O., APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14114 BUSINESS CENTER DR STE A
MORENO VALLEY CA
92553-9113
US

IV. Provider business mailing address

14114 BUSINESS CENTER DR STE A
MORENO VALLEY CA
92553-9113
US

V. Phone/Fax

Practice location:
  • Phone: 951-697-4133
  • Fax: 951-697-4130
Mailing address:
  • Phone: 951-697-4133
  • Fax: 951-697-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A5397
License Number StateCA

VIII. Authorized Official

Name: ROSEMARIE TWEED
Title or Position: OWNER
Credential: D.O.
Phone: 951-697-4133