Renato de la Rosa MD Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A65330 Issued in CA

Legal business name

RENATO DE LA ROSA MD INC

Practice address

754 Medical Center CT Ste 103
Chula Vista, CA 91911-6655

Phone

(619) 397-5001

Fax

(619) 397-4460

NPI assigned

Nov 9, 2012

Last updated

Oct 20, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Renato De la RosaNPI 1114966777

Title

MD

Phone

(619) 397-5001

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Renato De la Rosa, MD

  • Internal Medicine Physician
  • Chula Vista, CA
  • NPI 1114966777
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1073867297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "754 MEDICAL CENTER CT STE 103",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919116655",
            "telephone_number": "619-397-5001",
            "fax_number": "619-397-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "754 MEDICAL CENTER CT STE 103",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919116655",
            "telephone_number": "619-397-5001",
            "fax_number": "619-397-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENATO DE LA ROSA MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-09",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "DE LA ROSA",
        "authorized_official_first_name": "RENATO",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "619-397-5001"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A65330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A653300",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Renewing Life

• Internal Medicine Physician in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.