Provider Demographics
NPI:1699766485
Name:TESORO, OLMEDO ALEXANDER ROLDAN (MD)
Entity type:Individual
Prefix:DR
First Name:OLMEDO
Middle Name:ALEXANDER ROLDAN
Last Name:TESORO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4933
Mailing Address - Country:US
Mailing Address - Phone:844-364-2778
Mailing Address - Fax:253-274-7991
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:844-364-2778
Practice Address - Fax:253-274-7991
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043243207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016611Medicaid
WA0236637OtherSTATE L&I
WA0236637OtherSTATE L&I
WA8400699Medicaid
WAG8873976Medicare PIN