Provider Demographics
NPI:1134912074
Name:JIAO, RANDEL DE LA ROSA (MA)
Entity type:Individual
Prefix:
First Name:RANDEL
Middle Name:DE LA ROSA
Last Name:JIAO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S MICHIGAN AVE APT 2108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3308
Mailing Address - Country:US
Mailing Address - Phone:951-581-2908
Mailing Address - Fax:
Practice Address - Street 1:1255 S MICHIGAN AVE APT 2108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3308
Practice Address - Country:US
Practice Address - Phone:951-581-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health