Healthcare Provider Details

I. General information

NPI: 1235356197
Provider Name (Legal Business Name): RONALD SPINKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 THE ALAMEDA
BERKELEY CA
94707-2311
US

IV. Provider business mailing address

921 THE ALAMEDA
BERKELEY CA
94707-2311
US

V. Phone/Fax

Practice location:
  • Phone: 510-527-4825
  • Fax:
Mailing address:
  • Phone: 510-527-4825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG7970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: