Cindy Grace De la Rosa, M.D.
Individual provider Active NPI Pediatrics Physician · Celina, OH
NPI 1407830276 · NPPES record last updated Sep 12, 2014
Key facts
- NPI
- 1407830276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 35.092951 (OH)
- Practice address
- 801 Pro Dr
Grand Lake Family Practice & Pediatrics
Celina, OH 45822-3307 - Phone
- (419) 394-3387
- Fax
- (419) 586-8509
- NPI assigned
- Dec 5, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.092951 | OH | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-County Pediatrics, Inc | Pediatrics | Past | Accepting new patients |
| Einstein Practice Plan Inc | Pediatrics | Past | Accepting new patients |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35.092951 | OH | Yes |
Addresses
Primary practice location
801 Pro Dr
Grand Lake Family Practice & Pediatrics
Celina, OH 45822-3307
Mailing address
200 Saint Clair Ave
JTDM Family Practice, LLC
Saint Marys, OH 45885-2400
Phone (419) 394-3387
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9934723 | Other | OH | GROUP PTAN |
| 1942630348 | Other | OH | GROUP NPI - GRAND LAKE FAMILY PRACTICE & PEDIATRICS |
| 2927613 | Medicaid | OH |
Other providers in Celina, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.