Healthcare Provider Details

I. General information

NPI: 1841395266
Provider Name (Legal Business Name): RICK TRAUTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 DWIGHT WAY STE 302
BERKELEY CA
94704-2633
US

IV. Provider business mailing address

2006 DWIGHT WAY STE 302
BERKELEY CA
94704-2633
US

V. Phone/Fax

Practice location:
  • Phone: 510-649-1592
  • Fax: 510-649-1593
Mailing address:
  • Phone: 510-649-1592
  • Fax: 510-649-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG51989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: