Provider Demographics
NPI:1295394658
Name:LA ROSA, PAT F
Entity Type:Individual
Prefix:MS
First Name:PAT
Middle Name:F
Last Name:LA ROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-136 KUPUOHI PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1122
Mailing Address - Country:US
Mailing Address - Phone:808-777-8422
Mailing Address - Fax:
Practice Address - Street 1:94-136 KUPUOHI PL
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1122
Practice Address - Country:US
Practice Address - Phone:808-777-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9899164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse