Active NPI
Vincent Rosario Rodriguez, PA-C
- Physician Assistant
- Barstow, CA
National Provider Identifier
1639388796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 56585
- Practice address
- Branch Medical Clinic Barstow
BDLG 17 Marine Corps Logistics Base
Barstow, CA 92311-5050 - Phone
- (760) 577-6491
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 56585 | CA | Primary |
Addresses
Primary practice location
Branch Medical Clinic Barstow
BDLG 17 Marine Corps Logistics Base
Barstow, CA 92311-5050
Mailing address
3760 Convoy St
San Diego, CA 92111-3742
Phone (619) 200-9145
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56585 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695081600000",
"number": "1639388796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3760 CONVOY ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921113742",
"telephone_number": "619-200-9145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BRANCH MEDICAL CLINIC BARSTOW",
"address_2": "BDLG 17 MARINE CORPS LOGISTICS BASE",
"city": "BARSTOW",
"state": "CA",
"postal_code": "923115050",
"telephone_number": "760-577-6491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "VINCENT",
"middle_name": "ROSARIO",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2023-09-19",
"certification_date": "2023-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "56585",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Barstow, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.