Healthcare Provider Details

I. General information

NPI: 1770700627
Provider Name (Legal Business Name): DEBORAH AMY ROVINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FREMONT AVE STE 250D
LOS ALTOS CA
94024
US

IV. Provider business mailing address

#2559 P.O. BOX 1318
SACRAMENTO CA
95812
US

V. Phone/Fax

Practice location:
  • Phone: 650-690-1823
  • Fax:
Mailing address:
  • Phone: 650-690-1823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA88021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: