Healthcare Provider Details

I. General information

NPI: 1861468373
Provider Name (Legal Business Name): DENISE A. RETTENMAIER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CALIFORNIA DR C/O MEDICAL STAFF OFFICE
YOUNTVILLE CA
94599-1412
US

IV. Provider business mailing address

PO BOX 942895
SACRAMENTO CA
94295-0001
US

V. Phone/Fax

Practice location:
  • Phone: 707-944-4716
  • Fax: 707-944-5052
Mailing address:
  • Phone: 916-653-0080
  • Fax: 916-653-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number20A6474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: