Provider Demographics
NPI:1568141901
Name:DE LA ROSA MARTINEZ, ANDREA ALEXA (BS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ALEXA
Last Name:DE LA ROSA MARTINEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PERTH PL APT 104
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3312
Mailing Address - Country:US
Mailing Address - Phone:407-989-8520
Mailing Address - Fax:
Practice Address - Street 1:830 PERTH PL APT 104
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3312
Practice Address - Country:US
Practice Address - Phone:407-989-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator