Individual
CINDY GRACE DE LA ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
801 PRO DR, GRAND LAKE FAMILY PRACTICE & PEDIATRICS, CELINA, OH 45822-3307
(419) 394-3387
(419) 586-8509
Mailing address
200 SAINT CLAIR AVE, JTDM FAMILY PRACTICE, LLC, SAINT MARYS, OH 45885-2400
(419) 394-3387
(419) 586-8509
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35.092951
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942630348
GROUP NPI - GRAND LAKE FAMILY PRACTICE & PEDIATRICS
OH
05
—
2927613
—
OH
01
—
9934723
GROUP PTAN
OH
Enumeration date
12/05/2005
Last updated
09/12/2014
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