Provider Demographics
NPI:1902561491
Name:DE LA ROSA FAMILY VISION, PC
Entity Type:Organization
Organization Name:DE LA ROSA FAMILY VISION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:213-383-0836
Mailing Address - Street 1:105 1/2 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5904
Mailing Address - Country:US
Mailing Address - Phone:213-383-8036
Mailing Address - Fax:213-383-8036
Practice Address - Street 1:105 1/2 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5904
Practice Address - Country:US
Practice Address - Phone:213-383-8036
Practice Address - Fax:213-383-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty