Provider Demographics
NPI:1114128386
Name:DE PEREZ, ROSEMARY (NP MSN)
Entity type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:
Last Name:DE PEREZ
Suffix:
Gender:F
Credentials:NP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 POTRERO AVE BLDG.80 WD 86
Mailing Address - Street 2:SFGH AIDS - PHP CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-206-8676
Mailing Address - Fax:415-502-4777
Practice Address - Street 1:995 POTRERO AVE BLDG.80 WD 86
Practice Address - Street 2:SFGH AIDS - PHP CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-206-8676
Practice Address - Fax:415-502-4777
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN394241163WP2201X
CANPF4709363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
029470OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
P87782Medicare UPIN