NPIMap

Individual provider Active NPI

Renato De la Rosa, MD

  • Internal Medicine Physician
  • Chula Vista, CA
National Provider Identifier
1114966777
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A65330 Issued in CA
Practice address
754 Medical Center CT Ste 103
Chula Vista, CA 91911-6655
Phone
(619) 397-5001
Fax
(619) 397-4460
NPI assigned
Jun 6, 2006
Last updated
Oct 20, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A65330 CA Primary
Hospitalist Physician 208M00000X A65330 CA

Addresses

Primary practice location

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

Mailing address

754 Medical Center CT Ste 103
Chula Vista, CA 91911-6655
Phone (619) 397-5001

Other identifiers 1

IdentifierTypeStateIssuer
00A653300MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051004001142 CA Practitioner - Internal Medicine 3779518154 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1983
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Valerie C Altavas MD a Medical CorporationGroup PAC ID 5294826566, 2 clinicians

Practice addresses (Care Compare)

655 Euclid Ave
Suite 209
National City, CA 91950-2970
Phone (619) 470-7000

754 Medical Ctr CT
Suite 103
Chula Vista, CA 91911-6655
Phone (619) 397-5001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
65330CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Renato de la Rosa MD Inc Internal Medicine CurrentSince Oct 22, 2012 Accepting new patients
Valerie C. Altavas MD a Medical Corporation Internal Medicine CurrentSince Sep 1, 2021 Accepting new patients
Sharp Chula Vista Medical Center Past Accepting new patients

Locations

2060 Otay Lakes Rd
Ste 220
Chula Vista, CA 91913
Phone 6194767958201

754 Medical Center Ct
Ste 103
Chula Vista, CA 91911
Phone (619) 421-1111

655 Euclid Ave
Ste 209
National City, CA 91950
Phone (619) 267-9450

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1114966777",
    "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": {
        "last_name": "DE LA ROSA",
        "first_name": "RENATO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A65330",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A65330",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A653300",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.