Provider Demographics
NPI:1427199785
Name:RATTET, JEFFREY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
Last Name:RATTET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29798 HAUN ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6541
Mailing Address - Country:US
Mailing Address - Phone:909-886-6904
Mailing Address - Fax:909-881-6424
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:#524
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3878
Practice Address - Country:US
Practice Address - Phone:909-886-6904
Practice Address - Fax:909-881-6424
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053564A207N00000X
CAG32586207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G325860Medicaid
A45205Medicare UPIN
ZZZ23058ZMedicare ID - Type Unspecified