Healthcare Provider Details

I. General information

NPI: 1306792825
Provider Name (Legal Business Name): DULCE ROSA DE LA O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 MARTIN RD
COMMERCE TOWNSHIP MI
48390-1601
US

IV. Provider business mailing address

187 W ANN ARBOR AVE
PONTIAC MI
48340-1803
US

V. Phone/Fax

Practice location:
  • Phone: 248-289-3009
  • Fax:
Mailing address:
  • Phone: 248-821-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: