Provider Demographics
NPI:1427033703
Name:DELA ROSA, RUSSELL ANDRADA (CO)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:ANDRADA
Last Name:DELA ROSA
Suffix:
Gender:M
Credentials:CO
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Mailing Address - Street 1:3235 SANTA CRUZ RD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5857
Mailing Address - Country:US
Mailing Address - Phone:916-371-8287
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 1131
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6732
Practice Address - Fax:916-734-6734
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO# 2773OtherCERTIFIED ORTHOTIST