Healthcare Provider Details

I. General information

NPI: 1104904200
Provider Name (Legal Business Name): MARY D. OLOWIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MUIR RD
MARTINEZ CA
94553-4614
US

IV. Provider business mailing address

1800 HARRISON ST FL 7
OAKLAND CA
94612-3429
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-1000
  • Fax:
Mailing address:
  • Phone: 510-625-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG61967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: