Provider Demographics
NPI:1700857265
Name:DE LA ROSA, CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 N FRESNO ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2407
Mailing Address - Country:US
Mailing Address - Phone:559-438-2300
Mailing Address - Fax:559-438-1531
Practice Address - Street 1:7720 N FRESNO ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2407
Practice Address - Country:US
Practice Address - Phone:559-438-2300
Practice Address - Fax:559-438-1531
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA35812208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics