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Individual
ELAINE DE LA ROSA JEREZ
Active
Individual
ELAINE DE LA ROSA JEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
030292
NY
207QA0505X
Adult Medicine Physician
030292
NY
363A00000X
Physician Assistant
030292
NY
Other
Enumeration date
08/07/2023
Last updated
09/28/2023
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