Provider Demographics
NPI:1053358168
Name:DE LA ROSA, ARIEL JESUS (MD)
Entity type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:JESUS
Last Name:DE LA ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 TAMIAMI TRL N STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-8143
Mailing Address - Country:US
Mailing Address - Phone:239-261-2000
Mailing Address - Fax:
Practice Address - Street 1:2387 W 68TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6889
Practice Address - Country:US
Practice Address - Phone:305-232-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL95915174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist