Provider Demographics
NPI:1447484977
Name:ROTONDO, ERICA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:ANN
Last Name:ROTONDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:ANN
Other - Last Name:LOEHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 W LINE ST
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3314
Mailing Address - Country:US
Mailing Address - Phone:760-873-3561
Mailing Address - Fax:217-747-1351
Practice Address - Street 1:611 W LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3314
Practice Address - Country:US
Practice Address - Phone:760-873-3561
Practice Address - Fax:760-872-3197
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125567Medicaid
ILF400162906Medicare PIN