Healthcare Provider Details

I. General information

NPI: 1205007069
Provider Name (Legal Business Name): DAVID A ROVNO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 MOUNTAIN BLVD SUITE 240
OAKLAND CA
94611-2958
US

IV. Provider business mailing address

2220 MOUNTAIN BLVD SUITE 240
OAKLAND CA
94611-2958
US

V. Phone/Fax

Practice location:
  • Phone: 510-531-7523
  • Fax:
Mailing address:
  • Phone: 510-531-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC28917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: