Provider Demographics
NPI:1689768459
Name:RATNIEWSKI, ALFREDO (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:RATNIEWSKI
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 1:1151 E WASHINGTON AVE
Mailing Address - Street 2:STE C
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2254
Mailing Address - Country:US
Mailing Address - Phone:760-871-0606
Mailing Address - Fax:760-871-3534
Practice Address - Street 1:1151 E WASHINGTON AVE
Practice Address - Street 2:STE C
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2254
Practice Address - Country:US
Practice Address - Phone:760-871-0606
Practice Address - Fax:760-871-3534
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC42220GMedicare ID - Type Unspecified
CAB50761Medicare UPIN