Healthcare Provider Details

I. General information

NPI: 1841212669
Provider Name (Legal Business Name): PAUL KENT OPSVIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE OAKLAND CHILDRENS SERVICES STE 125D
OAKLAND CA
94605
US

IV. Provider business mailing address

7200 BANCROFT AVE OAKLAND CHILDRENS SERVICES STE 125D
OAKLAND CA
94605
US

V. Phone/Fax

Practice location:
  • Phone: 510-777-3892
  • Fax: 510-777-3880
Mailing address:
  • Phone: 510-777-3892
  • Fax: 510-777-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA20538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: