Provider Demographics
NPI:1538129846
Name:ALEX DEL ROSARIO MD INC
Entity Type:Organization
Organization Name:ALEX DEL ROSARIO MD INC
Other - Org Name:TERRA NOVA MEDICAL GROUUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-246-2270
Mailing Address - Street 1:5901 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 420B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4667
Mailing Address - Country:US
Mailing Address - Phone:310-246-2270
Mailing Address - Fax:310-246-2277
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 420B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:310-246-2270
Practice Address - Fax:310-246-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841259231OtherPERSONAL NPI
CA1841259231OtherPERSONAL NPI
CA=========OtherFEDERAL TAX ID
CAW14732Medicare ID - Type Unspecified