Provider Demographics
NPI:1689757627
Name:REMBUSKOS, TERRI M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:M
Last Name:REMBUSKOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4772 KATELLA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2683
Mailing Address - Country:US
Mailing Address - Phone:562-596-5552
Mailing Address - Fax:562-596-5340
Practice Address - Street 1:4772 KATELLA AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2683
Practice Address - Country:US
Practice Address - Phone:562-596-5552
Practice Address - Fax:562-596-5340
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABC081ZMedicare PIN
CAQ73746Medicare UPIN