Provider Demographics
NPI:1952331852
Name:RATHJEN, BONNIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:M
Last Name:RATHJEN
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 1:4125 MOHR AVE
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4749
Mailing Address - Country:US
Mailing Address - Phone:925-462-3664
Mailing Address - Fax:925-462-3666
Practice Address - Street 1:4125 MOHR AVE
Practice Address - Street 2:SUITE E-2
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4749
Practice Address - Country:US
Practice Address - Phone:925-462-3664
Practice Address - Fax:925-462-3666
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49432Medicare UPIN
CA00G436940Medicare ID - Type Unspecified