Provider Demographics
NPI:1205082013
Name:DE LA ROSA, ANDREA INEZ
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:INEZ
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 MOUNTAIN BLVD
Mailing Address - Street 2:BLDG. 69
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4500
Mailing Address - Country:US
Mailing Address - Phone:510-777-5300
Mailing Address - Fax:510-317-1444
Practice Address - Street 1:8750 MOUNTAIN BLVD
Practice Address - Street 2:BLDG. 69
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4500
Practice Address - Country:US
Practice Address - Phone:510-777-5300
Practice Address - Fax:510-317-1444
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor