Individual provider Active NPI

Raul Elguezabal, P.A.

  • Medical Physician Assistant
  • Chula Vista, CA
National Provider Identifier
1407918733
Registry record updated Jun 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
15431 Issued in CA
Practice address
480 Fourth Ave Ste 506
Chula Vista, CA 91910-4414
Phone
(619) 662-4100
Fax
(619) 662-4130
NPI assigned
Dec 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 15431 CA Primary

Addresses

Primary practice location

480 Fourth Ave Ste 506
Chula Vista, CA 91910-4414

Mailing address

480 Fourth Ave Ste 506
Chula Vista, CA 91910-4414
Phone (619) 662-4100

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070815000553 CA Practitioner - Physician Assistant 2062504400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1601 Precision Park LN
San Diego, CA 92173-1345

1615 Sweetwater Rd B
National City, CA 91950-7665

393 E Walnut St
Pasaden, CA 91188-0001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Nov 14, 2010 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 14, 2010 Accepting new patients

Locations

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780272000000",
    "number": "1407918733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 FOURTH AVE STE 506",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104414",
            "telephone_number": "619-662-4100",
            "fax_number": "619-662-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 FOURTH AVE STE 506",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104414",
            "telephone_number": "619-662-4100",
            "fax_number": "619-662-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELGUEZABAL",
        "first_name": "RAUL",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "15431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.