Healthcare Provider Details

I. General information

NPI: 1518901354
Provider Name (Legal Business Name): TERRI L ROCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 SANTA MONICA BLVD SUITE 335 EAST
SANTA MONICA CA
90404-2208
US

IV. Provider business mailing address

2021 SANTA MONICA BLVD SUITE 335 EAST
SANTA MONICA CA
90404-2208
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-7625
  • Fax: 310-319-2468
Mailing address:
  • Phone: 310-829-7625
  • Fax: 310-319-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA048669
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG8961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: