Provider Demographics
NPI:1689239295
Name:DE LA ROSA-PICON, ANA LUISA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LUISA
Last Name:DE LA ROSA-PICON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10220 FOOTHILL BLVD UNIT 10220
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0352
Mailing Address - Country:US
Mailing Address - Phone:909-560-3463
Mailing Address - Fax:
Practice Address - Street 1:10220 FOOTHILL BLVD UNIT 1204
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0344
Practice Address - Country:US
Practice Address - Phone:909-560-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician