=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841618386
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RACHEL HOYAL DPM INC A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2014
-----------------------------------------------------
Last Update Date | 05/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1041 4TH ST STE B
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95404-4329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-546-2107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1041 4TH ST STE. B
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95404-4329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-546-2107
-----------------------------------------------------
Fax | 707-573-0315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MRS. RACHEL ANN HOYAL
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 707-546-2107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | E4883
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------