Provider Demographics
NPI:1730478488
Name:BERSABE, ROSEMARIE (NP)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:BERSABE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:
Other - Last Name:DELA CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1642 E. CAPITOL EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1800
Mailing Address - Country:US
Mailing Address - Phone:408-445-3400
Mailing Address - Fax:408-238-3874
Practice Address - Street 1:1642 E. CAPITOL EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1800
Practice Address - Country:US
Practice Address - Phone:408-445-3400
Practice Address - Fax:408-238-3874
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily