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General NPI Number Information
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NPI Number | 1922010487
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Entity Type | Organization
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Legal Business Name | RICHARD L WACHT MD MEDICAL CORP
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 419 30TH ST
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City | OAKLAND
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State | CA
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Zip | 94609-3303
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Country | US
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Telephone | 510-444-4305
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Fax | 510-444-6356
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Provider Business Mailing Address
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Address Line | 419 30TH ST
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City | OAKLAND
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State | CA
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Zip | 94609-3303
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Country | US
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Telephone | 510-444-4305
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Fax | 510-444-6356
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD LEE WACHT
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Credential | MD
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Telephone | 510-444-4305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | A021202
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A021202
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License Number State | CA
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