MEDICARE: RACHEL THERESE PEDEMONTE FNP, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	651928	CA

General Provider Information

NPI Number	:	1144375478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL THERESE PEDEMONTE FNP, RN

Provider Business Mailing Address
First Line	:	30 BAYWOOD CT
Second Line	:
City	:	FAIRFAX
State	:	CA
Zip	:	94930-1705
Country	:	US
Telephone Number	:	415-250-3285
Fax Number	:

Provider Business Practice Location Address
First Line	:	2950 INTERNATIONAL BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-2902
Country	:	US
Telephone Number	:	510-535-4440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	02/10/2012

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