Healthcare Provider Details

I. General information

NPI: 1487414512
Provider Name (Legal Business Name): ROCKRIDGE CHILD PSYCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 ASHBY AVE
BERKELEY CA
94705-2453
US

IV. Provider business mailing address

5685 KEITH AVE
OAKLAND CA
94618-1542
US

V. Phone/Fax

Practice location:
  • Phone: 510-213-8866
  • Fax:
Mailing address:
  • Phone: 510-213-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EVAN TRAGER
Title or Position: MD
Credential: MD
Phone: 510-213-8866