Provider Demographics
NPI:1376588343
Name:HACKETHAL, CLAUDIA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:MARIA
Last Name:HACKETHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:MARIA
Other - Last Name:GERARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1010 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-8800
Mailing Address - Country:US
Mailing Address - Phone:805-546-7899
Mailing Address - Fax:805-546-7982
Practice Address - Street 1:1010 MURRAY ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-8800
Practice Address - Country:US
Practice Address - Phone:805-546-7899
Practice Address - Fax:805-546-7982
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8220702080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A822070OtherMEDICAL
CA00A822070OtherMEDICAL