Provider Demographics
NPI:1043409162
Name:QUIBUYEN, RODEN ROSARIO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RODEN
Middle Name:ROSARIO
Last Name:QUIBUYEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35000 GUADALCANAL ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92140-5599
Mailing Address - Country:US
Mailing Address - Phone:619-524-1963
Mailing Address - Fax:619-524-8072
Practice Address - Street 1:35000 GUADALCANAL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-5599
Practice Address - Country:US
Practice Address - Phone:619-524-1963
Practice Address - Fax:619-532-9510
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1710I1002X, 390200000X
CA1151164171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program