Healthcare Provider Details

I. General information

NPI: 1649432634
Provider Name (Legal Business Name): VANESSA S ROGERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA A SALGADO PA-C

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 LOUISIANA BLVD. NE SUITE C
ALBUQUERQUE NM
87113-1761
US

IV. Provider business mailing address

9484 PARKSIDE DR
WASHINGTON TOWNSHIP OH
45458-3545
US

V. Phone/Fax

Practice location:
  • Phone: 505-858-1222
  • Fax: 505-858-1224
Mailing address:
  • Phone: 937-941-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.004464
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004464RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: