Provider Demographics
NPI:1922678895
Name:DE LA ROSA, JALINE VIVIAN (AUD)
Entity Type:Individual
Prefix:
First Name:JALINE
Middle Name:VIVIAN
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 W TACON ST APT A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8063
Mailing Address - Country:US
Mailing Address - Phone:321-240-0972
Mailing Address - Fax:
Practice Address - Street 1:5 TAMPA GENERAL CIR STE 610
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3659
Practice Address - Country:US
Practice Address - Phone:813-315-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2487231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist