Individual
JACOB DELAROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
651 MEMORIAL DR, POCATELLO, ID 83201-4071
(208) 239-1000
Mailing address
777 HOSPITAL WAY STE 215, POCATELLO, ID 83201-5162
(208) 239-2580
(208) 239-2589
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
M9019
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M9019
STATE
ID
Enumeration date
02/20/2007
Last updated
03/19/2014
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