Provider Demographics
NPI:1902904618
Name:DE LA ROSA, BELEN (MS, APN, BC)
Entity Type:Individual
Prefix:MRS
First Name:BELEN
Middle Name:
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:MS, APN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 60TH ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2037
Mailing Address - Country:US
Mailing Address - Phone:630-852-2786
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE & ROOSEVELT ROAD
Practice Address - Street 2:BUILDING 228, ROOM 3067
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult