Provider Demographics
NPI:1295885002
Name:FUCHSHUBER, PASCAL R (MD)
Entity type:Individual
Prefix:
First Name:PASCAL
Middle Name:R
Last Name:FUCHSHUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:925-766-7725
Mailing Address - Fax:925-756-3440
Practice Address - Street 1:4053 LONE TREE WAY STE 200
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531
Practice Address - Country:US
Practice Address - Phone:925-776-7725
Practice Address - Fax:925-756-3440
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66285208G00000X, 207Q00000X
CA568657208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66285OtherSTATE MEDICAL LICENSE
CA00A662850Medicaid
CA00A662850Medicaid