Provider Demographics
NPI:1467532283
Name:DE LA ROSA, RITA GUEVARRA (MD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:GUEVARRA
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 BERGEN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4552
Mailing Address - Country:US
Mailing Address - Phone:201-433-0660
Mailing Address - Fax:201-433-0444
Practice Address - Street 1:779 BERGEN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4552
Practice Address - Country:US
Practice Address - Phone:201-433-0660
Practice Address - Fax:201-433-0444
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA035723208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3842703Medicaid