Provider Demographics
NPI:1558197293
Name:DE LA ROSA, DAVID GARZA
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GARZA
Last Name:DE LA ROSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6096
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-6096
Mailing Address - Country:US
Mailing Address - Phone:530-214-9238
Mailing Address - Fax:
Practice Address - Street 1:1450 SPRINGFIELD DR APT 147
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7313
Practice Address - Country:US
Practice Address - Phone:530-214-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker