Provider Demographics
NPI:1881989325
Name:RISHEL, HEATHER IRINA (MD PHD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:IRINA
Last Name:RISHEL
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:IRINA
Other - Last Name:COHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PHD
Mailing Address - Street 1:PO BOX 27097, 317 W PORTAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127
Mailing Address - Country:US
Mailing Address - Phone:800-275-8777
Mailing Address - Fax:
Practice Address - Street 1:345 W PORTAL AVE STE 320
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1429
Practice Address - Country:US
Practice Address - Phone:800-275-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248355390200000X
CA020048207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program