Healthcare Provider Details

I. General information

NPI: 1285617126
Provider Name (Legal Business Name): PAUL VINCENT ROCERETO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CAMINO DEL RIO S
SAN DIEGO CA
92108-3812
US

IV. Provider business mailing address

3110 CAMINO DEL RIO S
SAN DIEGO CA
92108-3812
US

V. Phone/Fax

Practice location:
  • Phone: 858-522-8585
  • Fax:
Mailing address:
  • Phone: 858-522-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberG89287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: