Provider Demographics
NPI:1497880801
Name:RATNESAR, QUEELAN (MD)
Entity Type:Individual
Prefix:DR
First Name:QUEELAN
Middle Name:
Last Name:RATNESAR
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 1:27001 CALAROGA AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4345
Mailing Address - Country:US
Mailing Address - Phone:510-783-6444
Mailing Address - Fax:510-783-6446
Practice Address - Street 1:27001 CALAROGA AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4345
Practice Address - Country:US
Practice Address - Phone:510-783-6444
Practice Address - Fax:510-783-6446
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA034726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88224Medicare UPIN