Healthcare Provider Details

I. General information

NPI: 1689864076
Provider Name (Legal Business Name): RANDY GEORGE SILVA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE RANDELL SILVA PD.D.

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 HILLTOP MALL RD STE 101
RICHMOND CA
94806-1948
US

IV. Provider business mailing address

1240 GENEVA AVE APT 5
SAN FRANCISCO CA
94112-3841
US

V. Phone/Fax

Practice location:
  • Phone: 510-323-2522
  • Fax:
Mailing address:
  • Phone: 415-290-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: