Provider Demographics
NPI:1720098874
Name:DELROSARIO, EUGENE (PA)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:DELROSARIO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S GARFIELD AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5859
Mailing Address - Country:US
Mailing Address - Phone:626-282-1600
Mailing Address - Fax:626-656-1261
Practice Address - Street 1:707 SOUTH GARFIELD AVE.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5859
Practice Address - Country:US
Practice Address - Phone:626-282-1600
Practice Address - Fax:626-656-1261
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP45645Medicare UPIN