Healthcare Provider Details

I. General information

NPI: 1376307249
Provider Name (Legal Business Name): RACHEL MARIE DOHERTY RDH, RDHAP, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL MARIE JOHNSON CNA

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 N MARTY AVE
FRESNO CA
93722-4186
US

IV. Provider business mailing address

1489 E MAGILL AVE
FRESNO CA
93710-4206
US

V. Phone/Fax

Practice location:
  • Phone: 559-209-1894
  • Fax: 559-270-4360
Mailing address:
  • Phone: 559-209-1894
  • Fax: 559-276-4360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number532
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number23414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: