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General NPI Number Information
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NPI Number | 1104430792
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Entity Type | Individual
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Provider Name | ANNA THERESE DE LA ROSA MAYOR PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 914 FAIR OAKS AVE
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3308
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Country | US
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Telephone | 626-441-3702
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Fax |
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Provider Business Mailing Address
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Address Line | 19215 E CAMPTON ST
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City | WEST COVINA
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State | CA
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Zip | 91792-2802
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Country | US
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Telephone |
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 83020
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License Number State | CA
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