MEDICARE: JOSEFA A DE LA ROSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1396251567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEFA A DE LA ROSA

Provider Business Mailing Address
First Line	:	1701 TOPPING AVE # 2F
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-7971
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 TOPPING AVE # 2F
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-7971
Country	:	US
Telephone Number	:	917-564-0144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2017
Last Update Date	:	12/22/2017

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Directions to “ JOSEFA A DE LA ROSA ” Practice Location

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