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General NPI Number Information
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NPI Number | 1407353311
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Entity Type | Individual
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Provider Name | GLYNIS TAN DEL ROSARIO NP
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Gender | Female
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Dates
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Enumeration Date | 04/07/2018
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 79440 CORPORATE CENTER DR
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City | LA QUINTA
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State | CA
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Zip | 92253-7241
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Country | US
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Telephone | 760-541-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 68577 SUSAN DR
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-2946
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Country | US
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Telephone | 760-449-4364
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NP95008832
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License Number State | CA
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