1881989325 NPI number — HEATHER IRINA RISHEL MD PHD

Table of content: HEATHER IRINA RISHEL MD PHD (NPI 1881989325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881989325 NPI number — HEATHER IRINA RISHEL MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RISHEL
Provider First Name:
HEATHER
Provider Middle Name:
IRINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COHN
Provider Other First Name:
HEATHER
Provider Other Middle Name:
IRINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881989325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27097, 317 W PORTAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-275-8777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 W PORTAL AVE STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94127-1429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-275-8777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  248355 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NP0225X , with the licence number: 020048 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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