Healthcare Provider Details

I. General information

NPI: 1073546479
Provider Name (Legal Business Name): WARREN I DOTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST SUITE 300
BERKELEY CA
94705-2146
US

IV. Provider business mailing address

2999 REGENT ST SUITE 300
BERKELEY CA
94705-2146
US

V. Phone/Fax

Practice location:
  • Phone: 510-540-5010
  • Fax: 510-540-0325
Mailing address:
  • Phone: 510-540-5010
  • Fax: 510-540-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG52256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: