Provider Demographics
NPI:1659833549
Name:FATCH, SHIREE SEGEV (DO)
Entity Type:Individual
Prefix:
First Name:SHIREE
Middle Name:SEGEV
Last Name:FATCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SPRUCE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2682
Mailing Address - Country:US
Mailing Address - Phone:415-668-8900
Mailing Address - Fax:
Practice Address - Street 1:525 SPRUCE ST STE 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2682
Practice Address - Country:US
Practice Address - Phone:415-668-8900
Practice Address - Fax:415-668-1695
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A20222208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program