Teresa Dudarewicz MD, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A65431 Issued in CA

Legal business name

TERESA DUDAREWICZ MD, INC.

Doing business as

Teresa Dudarewicz MD, Inc.

Practice address

11440 W Bernardo CT Ste 300
San Diego, CA 92127-1644

Phone

(858) 442-0753

NPI assigned

Dec 4, 2017

Last updated

Jul 23, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Teresa Dudarewicz, MDNPI 1679634406

Title

President

Phone

(858) 442-0753

Specialties & licenses 1

Addresses

Other names 1

• Teresa Dudarewicz MD, Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Teresa Dudarewicz, M.D.

  • Family Medicine Physician
  • La Jolla, CA
  • NPI 1679634406
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563840000000",
    "number": "1740795426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3937 SUMMER WAY",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920257942",
            "telephone_number": "858-442-0753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11440 W BERNARDO CT STE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921271644",
            "telephone_number": "858-442-0753"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3937 Summer Way",
            "address_purpose": "LOCATION",
            "city": "Escondido",
            "state": "CA",
            "postal_code": "920257942",
            "country_code": "US",
            "telephone_number": "858-442-0753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TERESA DUDAREWICZ MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-04",
        "last_updated": "2019-07-23",
        "status": "A",
        "authorized_official_last_name": "DUDAREWICZ",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-442-0753",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A65431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teresa Dudarewicz MD, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.