Provider Demographics
NPI:1083973994
Name:ROCKET PHYSICIAN ASSISTANT CORP
Entity Type:Organization
Organization Name:ROCKET PHYSICIAN ASSISTANT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHIAROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAGBITANG
Authorized Official - Suffix:
Authorized Official - Credentials:MMS, PA-C
Authorized Official - Phone:858-361-1441
Mailing Address - Street 1:3819 DIVISADERO ST
Mailing Address - Street 2:#2
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-1079
Mailing Address - Country:US
Mailing Address - Phone:415-580-7975
Mailing Address - Fax:415-520-2021
Practice Address - Street 1:4351 FOXFORD WAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7819
Practice Address - Country:US
Practice Address - Phone:415-580-7975
Practice Address - Fax:415-520-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 22186363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty