Healthcare Provider Details

I. General information

NPI: 1548583396
Provider Name (Legal Business Name): RACHEL WATTIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE M691
SAN FRANCISCO CA
94143-0110
US

IV. Provider business mailing address

294 CARL ST APT. 1
SAN FRANCISCO CA
94117-3818
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5001
  • Fax:
Mailing address:
  • Phone: 203-671-6203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNOT YET LICENSED
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: