Provider Demographics
NPI:1285834309
Name:HAERTEL, RONA SHARON (PA-C)
Entity type:Individual
Prefix:MS
First Name:RONA
Middle Name:SHARON
Last Name:HAERTEL
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 1:780 S AIRPORT BLVD
Mailing Address - Street 2:INTERNATIONAL TERMINAL LEVEL 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94128
Mailing Address - Country:US
Mailing Address - Phone:650-821-5601
Mailing Address - Fax:650-821-5662
Practice Address - Street 1:780 S AIRPORT BLVD
Practice Address - Street 2:INTERNATIONAL TERMINAL LEVEL 3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94128
Practice Address - Country:US
Practice Address - Phone:650-821-5601
Practice Address - Fax:650-821-5662
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12873363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12873OtherCALIFORNIA STATE BOARD PH