Healthcare Provider Details

I. General information

NPI: 1073832903
Provider Name (Legal Business Name): JESSICA PLAUCHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE DEPARTMENT OF PSYCHIATRY
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1001 POTRERO AVE DEPARTMENT OF PSYCHIATRY
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5323
  • Fax: 415-206-3142
Mailing address:
  • Phone: 415-206-5323
  • Fax: 415-206-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA118030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: