Provider Demographics
NPI:1356410880
Name:DEC, RHIAROSE MAGBITANG (PA)
Entity type:Individual
Prefix:
First Name:RHIAROSE
Middle Name:MAGBITANG
Last Name:DEC
Suffix:
Gender:F
Credentials:PA
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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:858-361-1441
Mailing Address - Fax:
Practice Address - Street 1:7100 REDWOOD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-4110
Practice Address - Country:US
Practice Address - Phone:858-361-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA22186363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56913901Medicaid
HIH100317Medicare PIN
HIQ41381Medicare UPIN