Healthcare Provider Details

I. General information

NPI: 1881248292
Provider Name (Legal Business Name): SARA XIOMARA RODRIGUEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 03/05/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON 200 MERCY CT
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

NAVAL HOSPITAL CAMP PENDLETON 200 MERCY CT
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1288
  • Fax:
Mailing address:
  • Phone: 607-725-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1161725
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9558
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: