Healthcare Provider Details

I. General information

NPI: 1730478488
Provider Name (Legal Business Name): ROSEMARIE BERSABE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSEMARIE DELA CRUZ NP

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 E. CAPITOL EXPRESSWAY
SAN JOSE CA
95121-1800
US

IV. Provider business mailing address

1642 E. CAPITOL EXPRESSWAY
SAN JOSE CA
95121-1800
US

V. Phone/Fax

Practice location:
  • Phone: 408-445-3400
  • Fax: 408-238-3874
Mailing address:
  • Phone: 408-445-3400
  • Fax: 408-238-3874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: