Provider Demographics
NPI:1740915149
Name:DE LA ROSA QUIROZ, RENE ALBERTO
Entity type:Individual
Prefix:MR
First Name:RENE
Middle Name:ALBERTO
Last Name:DE LA ROSA QUIROZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 FULTON ST OFC
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2014
Mailing Address - Country:US
Mailing Address - Phone:347-221-1414
Mailing Address - Fax:
Practice Address - Street 1:1240 MORRISON AVE # 7F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2705
Practice Address - Country:US
Practice Address - Phone:929-290-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)