Healthcare Provider Details

I. General information

NPI: 1477849339
Provider Name (Legal Business Name): SUSAN ALEXIS VACHON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 MARKET ST STE 94061
SAN FRANCISCO CA
94104-5401
US

IV. Provider business mailing address

548 MARKET ST STE 94061
SAN FRANCISCO CA
94104-5401
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-6879
  • Fax: 844-214-4888
Mailing address:
  • Phone: 800-321-6879
  • Fax: 844-214-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA4933
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601007846
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number13026
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-08972
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085004729
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number23014386
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00507400
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number014386
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110-005479
License Number StateVA
# 10
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4653-23
License Number StateWI
# 11
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA16639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: