Healthcare Provider Details

I. General information

NPI: 1982639365
Provider Name (Legal Business Name): ROSINA MARIE CULLINS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSINA MARIE MONACO O.D.

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5175 WARING RD
SAN DIEGO CA
92120-2705
US

IV. Provider business mailing address

5175 WARING RD
SAN DIEGO CA
92120-2705
US

V. Phone/Fax

Practice location:
  • Phone: 619-583-1000
  • Fax: 619-229-1938
Mailing address:
  • Phone: 619-583-1000
  • Fax: 619-229-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12360T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number12360T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: