Provider Demographics
NPI:1578083580
Name:DOUGLAS, RACHEL ANTONIA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANTONIA
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANTONIA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4146 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-2641
Mailing Address - Country:US
Mailing Address - Phone:925-628-3281
Mailing Address - Fax:
Practice Address - Street 1:2330 POST ST STE 270
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3466
Practice Address - Country:US
Practice Address - Phone:415-353-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3351231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist