Provider Demographics
NPI:1760096218
Name:DELA ROSA, MARIARACHELMERLUZA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:MARIARACHELMERLUZA
Middle Name:
Last Name:DELA ROSA
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:MA RACHEL
Other - Middle Name:MERLUZA
Other - Last Name:DELA ROSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:1794 N ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-1610
Mailing Address - Country:US
Mailing Address - Phone:818-207-6062
Mailing Address - Fax:
Practice Address - Street 1:2000 STADIUM WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2606
Practice Address - Country:US
Practice Address - Phone:213-250-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist