Provider Demographics
NPI:1679181440
Name:DE LA ROSA, ROGELIO (NP-C)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 LONG PRAIRIE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2709
Mailing Address - Country:US
Mailing Address - Phone:972-691-9190
Mailing Address - Fax:
Practice Address - Street 1:4135 BELT LINE RD STE 124
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5879
Practice Address - Country:US
Practice Address - Phone:469-495-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty