MEDICARE: EDWARD 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	26016	CA

General Provider Information

NPI Number	:	1619803491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD DE LA ROSA

Provider Business Mailing Address
First Line	:	325 N 6TH ST
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 N 6TH ST
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4205
Country	:	US
Telephone Number	:	323-245-6428
Fax Number	:

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

Provider Enumeration Date	:	06/20/2026
Last Update Date	:	06/20/2026

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Directions to “ EDWARD DE LA ROSA ” Practice Location

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