Provider Demographics
NPI:1861467615
Name:RITA BIESEN-BRADLEY, M.D., INC.
Entity Type:Organization
Organization Name:RITA BIESEN-BRADLEY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BIESEN-BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-784-8660
Mailing Address - Street 1:8207 SIERRA COLLEGE BLVD
Mailing Address - Street 2:500
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-9407
Mailing Address - Country:US
Mailing Address - Phone:916-784-8660
Mailing Address - Fax:916-784-7218
Practice Address - Street 1:8207 SIERRA COLLEGE BLVD
Practice Address - Street 2:500
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-9407
Practice Address - Country:US
Practice Address - Phone:916-784-8660
Practice Address - Fax:916-784-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42203207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C422030Medicaid
CA00C422030Medicaid
CAA37758Medicare UPIN