Provider Demographics
NPI:1124496690
Name:GATCHALIAN, RENZ LORENZ
Entity type:Individual
Prefix:
First Name:RENZ LORENZ
Middle Name:
Last Name:GATCHALIAN
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 1:2416 W TENNYSON RD APT 308
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4158
Mailing Address - Country:US
Mailing Address - Phone:510-909-4689
Mailing Address - Fax:
Practice Address - Street 1:2416 W TENNYSON RD APT 308
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4158
Practice Address - Country:US
Practice Address - Phone:510-909-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91773198E15141OtherMEDI CAL
CA95873198E89104OtherMEDI CAL
CA90718960F02067OtherMEDI CAL