Provider Demographics
NPI:1639508112
Name:ADLAO, MARIROSE (NP)
Entity Type:Individual
Prefix:
First Name:MARIROSE
Middle Name:
Last Name:ADLAO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 E AMAR RD
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1619
Mailing Address - Country:US
Mailing Address - Phone:626-444-2660
Mailing Address - Fax:626-448-1002
Practice Address - Street 1:3580 SANTA ANITA AVE
Practice Address - Street 2:#A
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2455
Practice Address - Country:US
Practice Address - Phone:626-444-2660
Practice Address - Fax:626-448-1002
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily