Provider Demographics
NPI:1518431972
Name:BECHTEL, NATHANIEL BURNS
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:BURNS
Last Name:BECHTEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NATE
Other - Middle Name:
Other - Last Name:BECHTEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:827 GARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-4633
Mailing Address - Country:US
Mailing Address - Phone:707-762-2624
Mailing Address - Fax:
Practice Address - Street 1:5500 CAMPANILE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92182-0003
Practice Address - Country:US
Practice Address - Phone:619-694-7651
Practice Address - Fax:619-594-7654
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program