Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jethro Payne De Vega La Rosa

Individual provider Physical Therapy Assistant · NPI 1720422983

Jethro Payne De Vega La Rosa is a Physical Therapy Assistant in Fremont, California. Licensed in California. Registered with an NPI since 2013.

Licensed in
CA
In the registry since
2013

Practice location Address checks out

39210 State St Ste 202
Fremont, CA 94538-1456
Phone: (510) 790-9480
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X (CA)

Record details

NPI number1720422983
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 18, 2013
Last updated in NPPESApril 18, 2013

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