Provider Demographics
NPI:1295846731
Name:DE LA ROSA, EFREN (DPM)
Entity Type:Individual
Prefix:
First Name:EFREN
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W CASTELLANO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6119
Mailing Address - Country:US
Mailing Address - Phone:915-532-3721
Mailing Address - Fax:
Practice Address - Street 1:114 W CASTELLANO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6119
Practice Address - Country:US
Practice Address - Phone:915-532-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5629880001Medicare NSC