NPIMap

Individual provider Active NPI

Angelica Buenrostro, PA-C

  • Medical Physician Assistant
  • Modesto, CA
National Provider Identifier
1720052418
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA18306 Issued in CA
Practice address
609 E Orangeburg Ave Ste 201
Modesto, CA 95350
Phone
(209) 572-3224
Fax
(209) 572-4528
NPI assigned
Feb 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 PA18306 CA Primary

Addresses

Primary practice location

609 E Orangeburg Ave Ste 201
Modesto, CA 95350

Mailing address

609 E Orangeburg Ave Ste 201
Modesto, CA 95350-5512
Phone (209) 572-3224

Other practice location 1

1860 S Sepulveda Blvd
Los Angeles, CA 90025-4314
Phone (310) 473-5807

Other practice location 2

100 E Valencia Mesa Dr Ste 310
Fullerton, CA 92835
Phone (714) 446-5200

Other identifiers 2

IdentifierTypeStateIssuer
1068658OtherCANCCPA CERTIFICATION
PA18306OtherCAPA LICENSE

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
I20060411000523 CA Practitioner - Physician Assistant 4183633670 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sonora Community HospitalGroup PAC ID 4284538505, shared by 10 NPIs, 134 clinicians

Practice addresses (Care Compare)

680 Guzzi LN
Suite 102
Sonora, CA 95370-5288
Phone (209) 536-5780

Hospital & facility affiliations

  • Adventist Health Sonora Hospital, Sonora, CA, CCN 050335
  • Mark Twain Medical Center Hospital, San Andreas, CA, CCN 051332

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18306CAMDClinical Psychologist
PA18306CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sonora Community Hospital CurrentSince Feb 3, 2025 Accepting new patients
Adventist Health Physicians Network CurrentSince Jan 31, 2025 Accepting new patients
Sonora Community Hospital CurrentSince Feb 3, 2025 Accepting new patients
Adventist Health Physicians Network CurrentSince Jan 31, 2025 Accepting new patients
Beverly Hills Rejuvenation Center PastSince May 20, 2018 Accepting new patients
Agata-Venger Partnership Past Accepting new patients
Sonora Community Hospital Past Accepting new patients

Locations

680 Guzzi Ln
Ste 102
Sonora, CA 95370
Phone (209) 536-5780

900 Greenley Rd
Ste 914
Sonora, CA 95370
Phone (209) 532-6128

193 Fairview Ln
Sonora, CA 95370
Phone (209) 536-5100

12811 Covey Cir
Sonora, CA 95370
Phone (209) 536-1785

680 Guzzi Ln
Ste 106
Sonora, CA 95370
Phone (209) 532-2792

1000 Greenley Rd
Sonora, CA 95370
Phone (209) 263-0803

193 Fairview Ln
Ste C
Sonora, CA 95370
Phone (209) 532-3124

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1720052418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 E ORANGEBURG AVE STE 201",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505512",
            "telephone_number": "209-572-3224",
            "fax_number": "209-572-4528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 E ORANGEBURG AVE STE 201",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95350",
            "telephone_number": "209-572-3224",
            "fax_number": "209-572-4528"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1860 S Sepulveda Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900254314",
            "country_code": "US",
            "telephone_number": "310-473-5807",
            "fax_number": "310-473-5801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 E Valencia Mesa Dr Ste 310",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "92835",
            "country_code": "US",
            "telephone_number": "714-446-5200",
            "fax_number": "714-446-5181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUENROSTRO",
        "first_name": "ANGELICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA18306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA CERTIFICATION",
            "identifier": "1068658",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA18306",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.