Healthcare Provider Details

I. General information

NPI: 1669036190
Provider Name (Legal Business Name): NICHOLAS DEL ROSARIO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27412 ENTERPRISE CIR W STE AND205
TEMECULA CA
92590-4803
US

IV. Provider business mailing address

27412 ENTERPRISE CIR W STE AND205
TEMECULA CA
92590-4803
US

V. Phone/Fax

Practice location:
  • Phone: 951-972-6262
  • Fax:
Mailing address:
  • Phone: 951-972-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: