Provider Demographics
NPI:1417126665
Name:RALEIGH J UNTERSEHER MD INC
Entity Type:Organization
Organization Name:RALEIGH J UNTERSEHER MD INC
Other - Org Name:ESPLANADE WOMENS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-332-9288
Mailing Address - Street 1:1315 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3330
Mailing Address - Country:US
Mailing Address - Phone:532-332-9288
Mailing Address - Fax:530-332-9261
Practice Address - Street 1:1315 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3330
Practice Address - Country:US
Practice Address - Phone:532-332-9288
Practice Address - Fax:530-332-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG585810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G585810Medicaid
CA00G585810Medicaid
CAZZZ24044ZMedicare PIN