Provider Demographics
NPI:1689563470
Name:DEL ROSARIO, JAYSON BERMUDEZ
Entity type:Individual
Prefix:
First Name:JAYSON
Middle Name:BERMUDEZ
Last Name:DEL ROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 GALLERY CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-4089
Mailing Address - Country:US
Mailing Address - Phone:707-319-0657
Mailing Address - Fax:707-419-4810
Practice Address - Street 1:2261 S WATNEY WAY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6757
Practice Address - Country:US
Practice Address - Phone:707-920-2831
Practice Address - Fax:707-419-4810
Is Sole Proprietor?:No
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator