Healthcare Provider Details

I. General information

NPI: 1639481757
Provider Name (Legal Business Name): TONY ROFFERS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3978 FOREST HILL AVE
OAKLAND CA
94602-2416
US

IV. Provider business mailing address

3542 FRUITVALE AVE #218
OAKLAND CA
94602-2327
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-6730
  • Fax:
Mailing address:
  • Phone: 510-531-6730
  • Fax: 510-531-6730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY3704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: