Provider Demographics
NPI:1730301706
Name:RAUCH, HERMAN SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:SAMUEL
Last Name:RAUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MRS
Other - First Name:CHLOE
Other - Middle Name:D
Other - Last Name:RAUCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:858 SYCAMORE LN.
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-1121
Mailing Address - Country:US
Mailing Address - Phone:619-444-1344
Mailing Address - Fax:
Practice Address - Street 1:858 SYCAMORE LN.
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1121
Practice Address - Country:US
Practice Address - Phone:619-444-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 28624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine