Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | R-7403 | CA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 2012015967 | MO |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | A106151 | CA |
NPI | 1720296007 |
---|---|
Provider Name | Teresa Mosqueda Ferguson |
First Address | Roseville, CA 95661-3027 |
Second Address | Roseville, CA 95661-3027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 10/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
784611 | ANTHEM BLUE CROSS BLUE SHIELD (01) | MO |