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NPI Code Detail

MEDICARE: JULIET M DE LA ROSA BS

MEDICARE: JULIET M DE LA ROSA BS
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1972866473
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIET M DE LA ROSA BS
Provider Business Mailing Address
First Line : 1650 SW 45TH PL
Second Line :
City : CORVALLIS
State : OR
Zip : 97333-1768
Country : US
Telephone Number : 541-758-8068
Fax Number :
Provider Business Practice Location Address
First Line : 1650 SW 45TH PL
Second Line :
City : CORVALLIS
State : OR
Zip : 97333-1768
Country : US
Telephone Number : 541-758-8068
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2012
Last Update Date : 06/19/2012

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