Basic Information
| Provider Information | |||||||||
| NPI: | 1184617524 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOGARD | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | RUTH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 508 GIBSON DR STE 290 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956785795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167814300 | ||||||||
| FaxNumber: | 9167814301 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 GIBSON DR STE 290 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956785795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164816800 | ||||||||
| FaxNumber: | 9164811881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G69673 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 2083P0901X | G69673 | CA | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0028370 | 05 | CA | MEDICAID |