Provider Demographics
NPI:1174601744
Name:RAPOSA, TERRY E (DO)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:E
Last Name:RAPOSA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 CLARKSVILLE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8210
Mailing Address - Country:US
Mailing Address - Phone:916-983-8868
Mailing Address - Fax:
Practice Address - Street 1:82 CLARKSVILLE RD STE 120
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8210
Practice Address - Country:US
Practice Address - Phone:916-983-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX69920Medicaid
G24654Medicare UPIN
020A69920Medicare ID - Type Unspecified