Provider Demographics
NPI:1215066055
Name:TACHE, STEPHANIE VERONIQUE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:VERONIQUE
Last Name:TACHE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CALIFORNIA STREET, BOX 0443
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0443
Mailing Address - Country:US
Mailing Address - Phone:415-502-6045
Mailing Address - Fax:415-476-3454
Practice Address - Street 1:1001 POTRERO AVENUE, WARD 83
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-206-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35716Medicare UPIN