License holder summary

JACOB DE LA ROSA is a Board Of Medicine licensed to practice in Idaho. The address on file for JACOB DE LA ROSA is 777 Hospital Way POCATELLO ID 83201. This licensed professional license is current. The license was granted 04/02/2004 and expired on 06/30/2018.

Idaho

Division of Occupational and Professional Licenses

JACOB DE LA ROSA
Board Of Medicine
License number
M-9019
Date granted
04/02/2004
Date expires
06/30/2018
Class
Board Of Medicine
Status
Renewed
Address
777 Hospital Way POCATELLO ID 83201
idaholicensing.com
ID 48344909
LAST UPDATED 2024-03-01 06:23:18 UTC

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