Provider Demographics
NPI:1508927252
Name:FOCHLER, SUSAN M (PA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:FOCHLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18675 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-2707
Mailing Address - Country:US
Mailing Address - Phone:510-889-1237
Mailing Address - Fax:
Practice Address - Street 1:7667 AMADOR VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2341
Practice Address - Country:US
Practice Address - Phone:925-828-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant