Healthcare Provider Details

I. General information

NPI: 1164825725
Provider Name (Legal Business Name): CRISTINA IGNACIO DEL ROSARIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA DEL ROSARIO

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

2113 SW ROSE LN
PORTLAND OR
97201-8013
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax:
Mailing address:
  • Phone: 650-201-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number777383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: