Provider Demographics
NPI:1881887412
Name:DE LA ROSA, CHRISTINA MARIE (MS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 NE IRVING ST STE 250
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2265
Mailing Address - Country:US
Mailing Address - Phone:503-233-4356
Mailing Address - Fax:
Practice Address - Street 1:1500 NE IRVING ST STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2265
Practice Address - Country:US
Practice Address - Phone:503-233-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health