Provider Demographics
NPI:1558433029
Name:BOMAR, ROCHELLE LENORE (DPM)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:LENORE
Last Name:BOMAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N MCDOWELL BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-8300
Mailing Address - Country:US
Mailing Address - Phone:707-763-4343
Mailing Address - Fax:707-283-4663
Practice Address - Street 1:231 N MCDOWELL BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-8300
Practice Address - Country:US
Practice Address - Phone:707-763-4343
Practice Address - Fax:707-283-4663
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00285213E00000X
CAE4200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E42000Medicare ID - Type Unspecified
CAU77065Medicare UPIN