Provider Demographics
NPI:1871374264
Name:BIDI, RETA (PA-C)
Entity type:Individual
Prefix:
First Name:RETA
Middle Name:
Last Name:BIDI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3636
Mailing Address - Country:US
Mailing Address - Phone:951-491-1042
Mailing Address - Fax:
Practice Address - Street 1:655 VENTURA AVE
Practice Address - Street 2:
Practice Address - City:OAK VIEW
Practice Address - State:CA
Practice Address - Zip Code:93022-9655
Practice Address - Country:US
Practice Address - Phone:805-649-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical