Provider Demographics
NPI:1033414669
Name:ROSENBERG, MATTHEW JARED (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JARED
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22 AREA MCMH BLDG 22190
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDELTON
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:910-581-6624
Mailing Address - Fax:
Practice Address - Street 1:101 BURROWS CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-8363
Practice Address - Country:US
Practice Address - Phone:910-581-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA65696363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1243697340OtherACTIVE DUTY MILITARY