Healthcare Provider Details

I. General information

NPI: 1952174682
Provider Name (Legal Business Name): ROGELIO PAMINSAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5007 KENNETH AVE
FAIR OAKS CA
95628-5329
US

IV. Provider business mailing address

244 SILTSTONE AVE
LATHROP CA
95330-8954
US

V. Phone/Fax

Practice location:
  • Phone: 209-601-4869
  • Fax:
Mailing address:
  • Phone: 209-601-4869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: