Provider Demographics
NPI:1255043113
Name:DE LA ROSA, DAPHNE JULIA
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:JULIA
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8144 ESCONDIDO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-1534
Mailing Address - Country:US
Mailing Address - Phone:661-678-3894
Mailing Address - Fax:
Practice Address - Street 1:8144 ESCONDIDO CANYON RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-1534
Practice Address - Country:US
Practice Address - Phone:661-678-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health