Individual provider Active NPI

Ivonne Elizabeth De la Rosa, M.D.

  • Pediatrics Physician
  • San Diego, CA
National Provider Identifier
1174695795
Registry record updated Mar 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A49734 Issued in CA
Practice address
9400 Ruffin CT Ste B
San Diego, CA 92123-5399
Phone
(858) 874-1033
NPI assigned
Nov 15, 2006
Last updated
Mar 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A49734 CA Primary

Addresses

Primary practice location

9400 Ruffin CT Ste B
San Diego, CA 92123-5399

Mailing address

3020 Childrens Way # Mc5003
San Diego, CA 92123-4223
Phone (858) 309-6300

Other practice location 1

3020 Childrens Way
San Diego, CA 92123-4223
Phone (858) 966-5818

Other practice location 2

9300 Valley Childrens Pl # Sc05
Madera, CA 93636-8761
Phone (559) 353-8769

Other identifiers 1

IdentifierTypeStateIssuer
00A497340MedicaidCA

Other names 1

  • Ivonne Elizabeth Maldonado Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211109003015 CA Practitioner - Pediatric Medicine 9638343783 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Children's Medical Group Pediatrics CurrentSince Aug 6, 2021 Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation PastSince Sep 27, 2020 Accepting new patients
Scripps Health Past Accepting new patients
Rady Children's Hospital San Diego Past Accepting new patients

Locations

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

2823 Fresno St
Fresno, CA 93721
Phone (559) 459-3965

9300 Valley Childrens Pl
Madera, CA 93636
Phone (559) 353-5700

9300 Valley Childrens Pl
#5
Madera, CA 93636
Phone (559) 353-5700

1524 McHenry Ave
Ste 550570
Modesto, CA 95350
Phone (209) 572-3880

400 W Mineral King Ave
Visalia, CA 93291
Phone (559) 624-2001

Interoperability endpoints

  • Direct secure messaging: idelarosa17779@valleychildrens-prd.direct-ci.com
  • Direct secure messaging: idelarosa9683@radychildrens.direct-ci.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1174695795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5003",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-309-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 RUFFIN CT STE B",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921235399",
            "telephone_number": "858-874-1033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3020 Childrens Way",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921234223",
            "country_code": "US",
            "telephone_number": "858-966-5818",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9300 Valley Childrens Pl # Sc05",
            "address_purpose": "LOCATION",
            "city": "Madera",
            "state": "CA",
            "postal_code": "936368761",
            "country_code": "US",
            "telephone_number": "559-353-8769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE LA ROSA",
        "first_name": "IVONNE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A49734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A497340",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IVONNE",
            "last_name": "MALDONADO",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.