Healthcare Provider Details

I. General information

NPI: 1831180132
Provider Name (Legal Business Name): ALLEN DOUGLAS OBRINSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PORTER DR SUITE 300
SAN RAMON CA
94583-1587
US

IV. Provider business mailing address

200 PORTER DR SUITE 300
SAN RAMON CA
94583-1587
US

V. Phone/Fax

Practice location:
  • Phone: 925-838-6500
  • Fax: 925-838-6542
Mailing address:
  • Phone: 925-838-6511
  • Fax: 925-838-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG61060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: