Provider Demographics
NPI:1215158027
Name:ROHBOCK, SUSAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:ROHBOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1123
Mailing Address - Street 2:
Mailing Address - City:JAMUL
Mailing Address - State:CA
Mailing Address - Zip Code:91935-1123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVY MEDICAL CLINIC - MARINE CORPS RECRUIT DEPOT
Practice Address - Street 2:35000 GUADALCANAL ST.
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140
Practice Address - Country:US
Practice Address - Phone:619-524-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1026283Medicare UPIN