Healthcare Provider Details

I. General information

NPI: 1881685295
Provider Name (Legal Business Name): RODRIGO AVELLANA CHENG JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG H-100, SANTA MARGARITA ROAD NAVAL HOSPITAL
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

BLDG H-100, SANTA MARGARITA ROAD NAVAL HOSPITAL
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1213
  • Fax: 760-725-1303
Mailing address:
  • Phone: 760-725-1213
  • Fax: 760-725-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN481187 NP 11428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: