Healthcare Provider Details

I. General information

NPI: 1295046407
Provider Name (Legal Business Name): LARRY U OZOWARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY STE 4190
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

PO BOX 1595
LAFAYETTE CA
94549-1595
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-4635
  • Fax: 510-204-3060
Mailing address:
  • Phone: 925-940-8395
  • Fax: 925-304-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA144182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: