Provider Demographics
NPI:1174632301
Name:DE LA ROSA, JONATHAN NEIL (HT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:NEIL
Last Name:DE LA ROSA
Suffix:
Gender:M
Credentials:HT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 E TORREY ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4141
Mailing Address - Country:US
Mailing Address - Phone:210-412-5837
Mailing Address - Fax:
Practice Address - Street 1:575 E TORREY ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4141
Practice Address - Country:US
Practice Address - Phone:210-412-5837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistology