Provider Demographics
NPI:1285369140
Name:DEL ROSARIO, EDWIN BULAONG (NP)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:BULAONG
Last Name:DEL ROSARIO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 THOMSEN RD
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-9507
Mailing Address - Country:US
Mailing Address - Phone:209-981-5927
Mailing Address - Fax:
Practice Address - Street 1:200 THOMSEN RD
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-9507
Practice Address - Country:US
Practice Address - Phone:209-981-5927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021829363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology