Provider Demographics
NPI:1992116156
Name:DEL ROSARIO, MARIE FAUSTENE GAMALLO (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:MARIE FAUSTENE
Middle Name:GAMALLO
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 W ORANGEWOOD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1954
Mailing Address - Country:US
Mailing Address - Phone:714-634-8500
Mailing Address - Fax:
Practice Address - Street 1:2127 W ORANGEWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1954
Practice Address - Country:US
Practice Address - Phone:714-634-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-15539103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst