1235327388 NPI number — MRS. RITA ANN BIESEN-BRADLEY M.D.

Table of content: MRS. RITA ANN BIESEN-BRADLEY M.D. (NPI 1235327388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235327388 NPI number — MRS. RITA ANN BIESEN-BRADLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIESEN-BRADLEY
Provider First Name:
RITA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIESEN
Provider Other First Name:
RITA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235327388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8207 SIERRA COLLEGE BLVD
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95661-9407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-784-8660
Provider Business Mailing Address Fax Number:
916-784-7218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8207 SIERRA COLLEGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-9407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-784-8660
Provider Business Practice Location Address Fax Number:
916-784-7218
Provider Enumeration Date:
10/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  C42203 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00C422030 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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