MEDICARE: JOSEPH 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	164X00000X	Licensed Vocational Nurse	756659	CA

General Provider Information

NPI Number	:	1346180874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH DE LA ROSA

Provider Business Mailing Address
First Line	:	401 S TUSTIN ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92866-2550
Country	:	US
Telephone Number	:	714-289-3936
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 S TUSTIN ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92866-2550
Country	:	US
Telephone Number	:	714-289-3936
Fax Number	:

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

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

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