MEDICARE: DR. DEBORAH S WACHS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A77813	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417980723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH S WACHS M.D.

Provider Business Mailing Address
First Line	:	100 PARK PLACE
Second Line	:	SUITE 200
City	:	SAN RAMON
State	:	CA
Zip	:	94583
Country	:	US
Telephone Number	:	925-867-1800
Fax Number	:	925-275-0933

Provider Business Practice Location Address
First Line	:	1101 S WINCHESTER BLVD
Second Line	:	SUITE O-282
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3901
Country	:	US
Telephone Number	:	925-867-1800
Fax Number	:	925-901-1481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	03/10/2014

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