Provider Demographics
NPI:1639388796
Name:RODRIGUEZ, VINCENT ROSARIO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:ROSARIO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:3760 CONVOY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3742
Mailing Address - Country:US
Mailing Address - Phone:619-200-9145
Mailing Address - Fax:
Practice Address - Street 1:BRANCH MEDICAL CLINIC BARSTOW
Practice Address - Street 2:BDLG 17 MARINE CORPS LOGISTICS BASE
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-5050
Practice Address - Country:US
Practice Address - Phone:760-577-6491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA56585363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant