Provider Demographics
NPI:1700583721
Name:DEL ROSARIO, JIKKO JOVEN BAUTISTA
Entity type:Individual
Prefix:
First Name:JIKKO JOVEN
Middle Name:BAUTISTA
Last Name:DEL ROSARIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3723
Mailing Address - Country:US
Mailing Address - Phone:626-824-6144
Mailing Address - Fax:
Practice Address - Street 1:8207 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3723
Practice Address - Country:US
Practice Address - Phone:626-824-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4923224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant