Provider Demographics
NPI:1417980723
Name:WACHS, DEBORAH S (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:S
Last Name:WACHS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 PARK PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-867-1800
Mailing Address - Fax:925-275-0933
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:SUITE O-282
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:925-867-1800
Practice Address - Fax:925-901-1481
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2014-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA77813207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A778130Medicaid
CA00A778130Medicaid
CAWA77813AMedicare ID - Type Unspecified