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General NPI Number Information
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NPI Number | 1639388796
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Entity Type | Individual
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Provider Name | VINCENT ROSARIO RODRIGUEZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | BRANCH MEDICAL CLINIC BARSTOW BDLG 17 MARINE CORPS LOGISTICS BASE
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City | BARSTOW
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State | CA
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Zip | 92311-5050
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Country | US
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Telephone | 760-577-6491
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Fax |
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Provider Business Mailing Address
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Address Line | 3760 CONVOY ST
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City | SAN DIEGO
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State | CA
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Zip | 92111-3742
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Country | US
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Telephone | 619-200-9145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 56585
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License Number State | CA
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