Provider Demographics
NPI:1639949050
Name:PALACPAC, ROSELLE CREZ DULATRE
Entity Type:Individual
Prefix:
First Name:ROSELLE CREZ
Middle Name:DULATRE
Last Name:PALACPAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSELLE
Other - Middle Name:
Other - Last Name:PALACPAC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1340 TULLY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3055
Mailing Address - Country:US
Mailing Address - Phone:408-505-5575
Mailing Address - Fax:
Practice Address - Street 1:1340 TULLY RD STE 301
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3055
Practice Address - Country:US
Practice Address - Phone:408-505-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist