Provider Demographics
NPI:1033246939
Name:BHARDWAJ, RATANA GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:RATANA
Middle Name:GRACE
Last Name:BHARDWAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2570
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91319-2570
Mailing Address - Country:US
Mailing Address - Phone:800-386-8024
Mailing Address - Fax:805-375-8903
Practice Address - Street 1:10150 SORRENTO VALLEY RD
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1635
Practice Address - Country:US
Practice Address - Phone:858-454-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC527662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C527660Medicaid
CA00C527660Medicaid