Healthcare Provider Details

I. General information

NPI: 1891164307
Provider Name (Legal Business Name): MICHAEL DEL ROSARIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E SOUTH ST STE 304
LAKEWOOD CA
90805-4594
US

IV. Provider business mailing address

3300 E SOUTH ST STE 304
LAKEWOOD CA
90805-4594
US

V. Phone/Fax

Practice location:
  • Phone: 562-232-0550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA151675
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA151675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: