Provider Demographics
NPI:1659335701
Name:DE LA ROSA, JOSE LUIS (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:DE LA ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16415 COLORADO AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5035
Mailing Address - Country:US
Mailing Address - Phone:562-531-0733
Mailing Address - Fax:562-531-0733
Practice Address - Street 1:16415 COLORADO AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5035
Practice Address - Country:US
Practice Address - Phone:562-531-0733
Practice Address - Fax:562-531-0733
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA43518207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7051217Medicaid
CA7051217Medicaid