Provider Demographics
NPI:1578622296
Name:RETTGERS, BONNIE (AUD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:RETTGERS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:BONNIE
Other - Middle Name:JEAN
Other - Last Name:RETTGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:450 FLETCHER PKWY,
Mailing Address - Street 2:#112
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-5423
Mailing Address - Country:US
Mailing Address - Phone:818-515-7805
Mailing Address - Fax:
Practice Address - Street 1:450 FLETCHER PKWY STE 112
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2520
Practice Address - Country:US
Practice Address - Phone:818-515-7805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU760231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist