Active NPI
Edwin Bulaong Del Rosario, NP
- Gerontology Nurse Practitioner
- Lathrop, CA
National Provider Identifier
1285369140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 95021829
- Practice address
- 200 Thomsen Rd
Lathrop, CA 95330-9507 - Phone
- (209) 981-5927
- NPI assigned
- Jul 22, 2022
- Last updated
- Jul 22, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 95021829 | CA | Primary |
Addresses
Primary practice location
200 Thomsen Rd
Lathrop, CA 95330-9507
Mailing address
200 Thomsen Rd
Lathrop, CA 95330-9507
Phone (209) 981-5927
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95021829 | CA | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658448000000",
"number": "1285369140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 THOMSEN RD",
"city": "LATHROP",
"state": "CA",
"postal_code": "953309507",
"telephone_number": "209-981-5927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 THOMSEN RD",
"city": "LATHROP",
"state": "CA",
"postal_code": "953309507",
"telephone_number": "209-981-5927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEL ROSARIO",
"first_name": "EDWIN",
"middle_name": "BULAONG",
"name_prefix": "Mr.",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-07-22",
"last_updated": "2022-07-22",
"certification_date": "2022-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "CA",
"license": "95021829",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lathrop, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.