Provider Demographics
NPI:1104533983
Name:DELA ROSA, NOREEN RENAE SABLAN
Entity type:Individual
Prefix:
First Name:NOREEN RENAE
Middle Name:SABLAN
Last Name:DELA ROSA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 BAKER ST STE A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4566
Mailing Address - Country:US
Mailing Address - Phone:714-361-6760
Mailing Address - Fax:
Practice Address - Street 1:3901 S FIFE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7309
Practice Address - Country:US
Practice Address - Phone:253-589-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
WACG61668972101YM0800X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker