Provider Demographics
NPI:1760682421
Name:DEL ROSARIO, JENNIE ENCABO (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:ENCABO
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2818
Mailing Address - Country:US
Mailing Address - Phone:907-562-2118
Mailing Address - Fax:
Practice Address - Street 1:2612 EAGLE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2818
Practice Address - Country:US
Practice Address - Phone:907-562-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1531OtherMUNICIPALITY OF ANCHORAGE