Healthcare Provider Details

I. General information

NPI: 1326213034
Provider Name (Legal Business Name): MICHAEL RATTER, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9619 CHESAPEAKE DR SUITE 102
SAN DIEGO CA
92123-1368
US

IV. Provider business mailing address

9619 CHESAPEAKE DR SUITE 102
SAN DIEGO CA
92123-1368
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1212
  • Fax: 858-279-1420
Mailing address:
  • Phone: 858-279-1212
  • Fax: 858-279-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG56347
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG56347
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL LEONARD RATTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-658-4903