Provider Demographics
NPI:1285720292
Name:ROSSER, TENA LA DAWN (MD)
Entity type:Individual
Prefix:
First Name:TENA
Middle Name:LA DAWN
Last Name:ROSSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 SUNSET BOULEVARD
Mailing Address - Street 2:M.S. #82
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2940
Mailing Address - Fax:323-361-1109
Practice Address - Street 1:4650 SUNSET BOULEVARD
Practice Address - Street 2:M.S. #82
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2940
Practice Address - Fax:323-361-1109
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA886682084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A886680Medicaid
CA00A886680 L59OtherCAL OPTIMA
CAWA88668AMedicare ID - Type Unspecified
CA00A886680Medicaid
CA00A886680 L59OtherCAL OPTIMA