Provider Demographics
NPI:1356478788
Name:DELA ROSA, ALFREDO A JR (DDS, MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:A
Last Name:DELA ROSA
Suffix:JR
Gender:M
Credentials:DDS, MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6063 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2007
Mailing Address - Country:US
Mailing Address - Phone:415-963-4121
Mailing Address - Fax:
Practice Address - Street 1:6063 MISSION ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2007
Practice Address - Country:US
Practice Address - Phone:415-963-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery