| Renato De La Rosa Md Inc | |
|
754 Medical Center Ct Ste 103 Chula Vista CA 91911-6655 | |
| (619) 397-5001 | |
| (619) 397-4460 |
| Full Name | Renato De La Rosa Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 754 Medical Center Ct Ste 103, Chula Vista, California |
| Authorized Official Name and Position | Renato De La Rosa (MD) |
| Authorized Official Contact | 6193975001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renato De La Rosa Md Inc 754 Medical Center Ct Ste 103 Chula Vista CA 91911-6655 Ph: (619) 397-5001 | Renato De La Rosa Md Inc 754 Medical Center Ct Ste 103 Chula Vista CA 91911-6655 Ph: (619) 397-5001 |
| NPI Number | 1073867297 |
|---|---|
| Provider Enumeration Date | 11/09/2012 |
| Last Update Date | 10/20/2021 |
| Medicare PECOS PAC ID | 5294987657 |
|---|---|
| Medicare Enrollment ID | O20121211000107 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073867297 | NPI | - | NPPES |
| 00A653300 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A65330 (California) | Primary |
| Provider Name | Renato C De La Rosa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114966777 PECOS PAC ID: 3779518154 Enrollment ID: I20051004001142 |
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