Provider Demographics
NPI:1811909096
Name:OMACHI, RODNEY S (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:S
Last Name:OMACHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:60 EL VERANO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2037
Mailing Address - Country:US
Mailing Address - Phone:415-665-3400
Mailing Address - Fax:415-584-5130
Practice Address - Street 1:1738 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1737
Practice Address - Country:US
Practice Address - Phone:415-665-3400
Practice Address - Fax:415-584-8705
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24941207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G249410Medicaid
CA00G249410Medicare PIN
CAA42453Medicare UPIN