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General NPI Number Information
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NPI Number | 1083247530
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Entity Type | Individual
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Provider Name | JOSHUA DELAROSA MPAS, PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 3801 SPRING ST
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City | MOUNT PLEASANT
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State | WI
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Zip | 53405-1667
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Country | US
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Telephone | 262-687-4011
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Fax |
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Provider Business Mailing Address
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Address Line | 10625 W NORTH AVE STE 102
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City | WAUWATOSA
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State | WI
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Zip | 53226-2315
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Country | US
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Telephone | 414-877-5350
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Fax | 414-877-5360
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5142-23
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License Number State | WI
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