Healthcare Provider Details

I. General information

NPI: 1942429535
Provider Name (Legal Business Name): JERRY D DELROSARIO SR. R.R.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. JERRY D DEL ROSARIO SR.

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 79TH ST
WILLOWBROOK IL
60527-2404
US

IV. Provider business mailing address

306 79TH ST
WILLOWBROOK IL
60527-2404
US

V. Phone/Fax

Practice location:
  • Phone: 630-325-2931
  • Fax: 630-455-1307
Mailing address:
  • Phone: 630-325-2931
  • Fax: 630-455-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225B00000X
TaxonomyPulmonary Function Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: