Healthcare Provider Details

I. General information

NPI: 1578083580
Provider Name (Legal Business Name): RACHEL ANTONIA DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ANTONIA SMITH AUD

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 POST ST STE 270
SAN FRANCISCO CA
94115-3466
US

IV. Provider business mailing address

4146 SEQUOIA DR
OAKLEY CA
94561-2641
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2015
  • Fax:
Mailing address:
  • Phone: 925-628-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: