Individual
MARIO DE LA ROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
715 E IDAHO AVE, LAS CRUCES, NM 88001-4703
(525) 526-3649
Mailing address
300 MENAUL BLVD NW STE A, ALBUQUERQUE, NM 87107-1347
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Enumeration date
02/14/2025
Last updated
02/14/2025
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