Provider Demographics
NPI:1912925611
Name:MICHA, RETTENMAIER, BROWN & LACEY A CALIFORNIA PARTNERSHIP
Entity Type:Organization
Organization Name:MICHA, RETTENMAIER, BROWN & LACEY A CALIFORNIA PARTNERSHIP
Other - Org Name:GYNECOLOGIC ONCOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:FIKRET
Authorized Official - Middle Name:
Authorized Official - Last Name:ATAMDEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-567-2534
Mailing Address - Street 1:22 CORPORATE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7985
Mailing Address - Country:US
Mailing Address - Phone:310-375-8446
Mailing Address - Fax:310-375-8489
Practice Address - Street 1:23600 TELO AVE STE 250
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4037
Practice Address - Country:US
Practice Address - Phone:310-375-8446
Practice Address - Fax:310-375-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15643ZMedicare PIN
CAW14463DMedicare PIN
CAGR0086021Medicaid
CAGR0086022Medicaid
CAW14463Medicare PIN