Individual provider Active NPI

Nathaniel Rosete Jr., PA-C

  • Physician Assistant
  • Fontana, CA
National Provider Identifier
1457530768
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA17245 Issued in CA
Practice address
9717 Sierra Ave
Fontana, CA 92335-6716
Phone
(909) 822-3400
Fax
(909) 822-2308
NPI assigned
Nov 2, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA17245 CA Primary

Addresses

Primary practice location

9717 Sierra Ave
Fontana, CA 92335-6716

Mailing address

9717 Sierra Ave
Fontana, CA 92335-6716
Phone (909) 822-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250205002835 CA Order and Referring Only - General PracticePractitioner - General Practice 3779013743

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA17245CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Eduardo Santos Uy MD Inc PastSince Jun 1, 2003 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IFJFBA/Endpoint/IFJFBA

Organizations & group practices 1

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": "1193961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1457530768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9717 SIERRA AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923356716",
            "telephone_number": "909-822-3400",
            "fax_number": "909-822-2308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9717 SIERRA AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923356716",
            "telephone_number": "909-822-3400",
            "fax_number": "909-822-2308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSETE",
        "first_name": "NATHANIEL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-02",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; 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.