Healthcare Provider Details

I. General information

NPI: 1386652253
Provider Name (Legal Business Name): RONALD JAMES SOVAK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 N SAN MATEO DR #2
SAN MATEO CA
94401-2543
US

IV. Provider business mailing address

327 N SAN MATEO DR #2
SAN MATEO CA
94401-2543
US

V. Phone/Fax

Practice location:
  • Phone: 650-348-1519
  • Fax: 650-843-1549
Mailing address:
  • Phone: 650-348-1519
  • Fax: 650-843-1549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS2400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: