Basic Information
| Provider Information | |||||||||
| NPI: | 1245337344 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RATLEY | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 Q ST | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958167058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167333333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 02/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A83628 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | A83628 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 2443808 | 01 | CA | UNITED HEALTHCARE | OTHER | 7208632 | 01 | CA | AETNA | OTHER | 00A836280 | 01 | CA | BLUE SHIELD | OTHER | 00A836280 | 05 | CA | MEDICAID | MCMG343700 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 236150 | 01 | CA | HEALTH NET | OTHER | 7071951 | 01 | CA | CIGNA | OTHER | 000810607467 | 01 | CA | PHCS | OTHER | A83628 | 01 | CA | BLUE CROSS | OTHER | 1806848 | 01 | CA | GREAT WEST | OTHER | 2237972 | 01 | CA | FIRST HEALTH | OTHER | 90141472 | 01 | CA | INTERPLAN | OTHER |