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Organization
RICHARD L WACHT MD MEDICAL CORP
Active
Organization
RICHARD L WACHT MD MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD LEE WACHT MD (OWNER)
(510) 444-4305
Entity
Organization
Contact information
Practice address
419 30TH ST, OAKLAND, CA 94609-3303
(510) 444-4305
(510) 444-6356
Mailing address
419 30TH ST, OAKLAND, CA 94609-3303
(510) 444-4305
(510) 444-6356
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
A021202
CA
207R00000X
Internal Medicine Physician
Primary
A021202
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0754737
CA CORP #
CA
01
—
21464656
STATE TAX ID
—
05
—
719 4316
—
CA
Enumeration date
08/13/2006
Last updated
09/29/2008
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