Provider Demographics
NPI:1407891617
Name:BOGEMA, PATRICIA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:BOGEMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:BALSAMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2083 COMPTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7283
Mailing Address - Country:US
Mailing Address - Phone:951-268-1001
Mailing Address - Fax:951-268-1005
Practice Address - Street 1:2083 COMPTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7283
Practice Address - Country:US
Practice Address - Phone:951-268-1001
Practice Address - Fax:951-268-1005
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
158669Medicare UPIN