MEDICARE: ANGELA LYNN DE LA ROSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1043169543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA LYNN DE LA ROSA

Provider Business Mailing Address
First Line	:	PO BOX 959
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98907-0959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2705 SAINT ANDREWS LOOP
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-3378
Country	:	US
Telephone Number	:	509-412-1051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “ ANGELA LYNN DE LA ROSA ” Practice Location

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