Provider Demographics
NPI:1356427728
Name:DELA ROSA, KRISTINA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:MARIE
Last Name:DELA ROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9878 HIBERT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1142
Mailing Address - Country:US
Mailing Address - Phone:858-693-3000
Mailing Address - Fax:858-693-3700
Practice Address - Street 1:9878 HIBERT ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1142
Practice Address - Country:US
Practice Address - Phone:858-693-3000
Practice Address - Fax:858-693-3700
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240218207R00000X
CAA147681207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty