Provider Demographics
NPI:1306979208
Name:TUTELA, ROCCO R JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:R
Last Name:TUTELA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11037 WARNER AVE
Mailing Address - Street 2:# 265
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4007
Mailing Address - Country:US
Mailing Address - Phone:732-846-9500
Mailing Address - Fax:732-846-3931
Practice Address - Street 1:11100 WARNER AVE STE 258
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7512
Practice Address - Country:US
Practice Address - Phone:714-868-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07918500208600000X
CAC168048208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery