Provider Demographics
NPI:1770022840
Name:MATAICH, RACHID
Entity Type:Individual
Prefix:MR
First Name:RACHID
Middle Name:
Last Name:MATAICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2763 WHEELING ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-2709
Mailing Address - Country:US
Mailing Address - Phone:720-400-6541
Mailing Address - Fax:
Practice Address - Street 1:2763 WHEELING ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-2709
Practice Address - Country:US
Practice Address - Phone:720-400-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09-320-0073172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver