Provider Demographics
NPI:1376307249
Name:DOHERTY, RACHEL MARIE (RDH, RDHAP, MPH)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:RDH, RDHAP, MPH
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:1489 E MAGILL AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-4206
Mailing Address - Country:US
Mailing Address - Phone:559-209-1894
Mailing Address - Fax:559-276-4360
Practice Address - Street 1:4615 N MARTY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-4186
Practice Address - Country:US
Practice Address - Phone:559-209-1894
Practice Address - Fax:559-270-4360
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532124Q00000X
CA23414124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist