Provider Demographics
NPI:1346876869
Name:DELAROSA, MARCO
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:DELAROSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E GILBERT ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0936
Mailing Address - Country:US
Mailing Address - Phone:909-387-7406
Mailing Address - Fax:909-387-7047
Practice Address - Street 1:900 E GILBERT ST STE 4
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-1622
Practice Address - Country:US
Practice Address - Phone:909-387-7406
Practice Address - Fax:909-387-7047
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA053470323101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)