MEDICARE: JENNIFER RODRIGUEZ FOSTER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.006149	OH
2	363A00000X	Physician Assistant	C06155	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033669163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RODRIGUEZ FOSTER PA-C

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD BLDG B
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-991-3188
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 MIAMI VALLEY DR STE 160
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4774
Country	:	US
Telephone Number	:	937-435-4263
Fax Number	:	937-298-9459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	06/03/2026

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