Provider Demographics
NPI:1205945144
Name:DELROSARIO, GENEVIEVE A (PA-C)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:A
Last Name:DELROSARIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-977-8635
Mailing Address - Fax:314-977-8649
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-977-8635
Practice Address - Fax:314-977-8649
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00777363A00000X
MO2012017129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100409070AMedicaid
KS425910OtherFIRSTGUARD
970022263OtherRR MEDICARE
P43433Medicare UPIN
KS425910OtherFIRSTGUARD