Healthcare Provider Details

I. General information

NPI: 1326701749
Provider Name (Legal Business Name): OSCAR JAVIER DE LA ROSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 06/27/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 TACOMA ST
WORCESTER MA
01605-3516
US

IV. Provider business mailing address

6 MAPLE ST
WHITINSVILLE MA
01588-2217
US

V. Phone/Fax

Practice location:
  • Phone: 508-532-7331
  • Fax:
Mailing address:
  • Phone: 774-482-0472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2357635
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2357635
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: