Healthcare Provider Details

I. General information

NPI: 1700749280
Provider Name (Legal Business Name): ROSSY RENDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 CARMEL MOUNTAIN RD STE 208B
SAN DIEGO CA
92130-4861
US

IV. Provider business mailing address

4332 CAMINITO DEL ZAFIRO
SAN DIEGO CA
92121-1906
US

V. Phone/Fax

Practice location:
  • Phone: 760-261-9814
  • Fax:
Mailing address:
  • Phone: 760-261-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: