Provider Demographics
NPI:1134344989
Name:DE LA ROSA, ELLY MERCEDES (PHL)
Entity type:Individual
Prefix:
First Name:ELLY
Middle Name:MERCEDES
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CALLE ADRIANO GONZALEZ
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4406
Mailing Address - Country:US
Mailing Address - Phone:787-878-1809
Mailing Address - Fax:787-878-1809
Practice Address - Street 1:621 AVE SAN LUIS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3666
Practice Address - Country:US
Practice Address - Phone:787-817-1245
Practice Address - Fax:787-879-9026
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist