Provider Demographics
NPI:1235327388
Name:BIESEN-BRADLEY, RITA ANN (MD)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:ANN
Last Name:BIESEN-BRADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:RITA
Other - Middle Name:ANN
Other - Last Name:BIESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8207 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-9407
Mailing Address - Country:US
Mailing Address - Phone:916-784-8660
Mailing Address - Fax:916-784-7218
Practice Address - Street 1:8207 SIERRA COLLEGE BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-9407
Practice Address - Country:US
Practice Address - Phone:916-784-8660
Practice Address - Fax:916-784-7218
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42203207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C422030Medicaid
CAA37758Medicare UPIN