Healthcare Provider Details

I. General information

NPI: 1376811596
Provider Name (Legal Business Name): JOHN R. ROSTKOWSKI, M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LA CASA VIA STE 213
WALNUT CREEK CA
94598-3078
US

IV. Provider business mailing address

130 LA CASA VIA STE 213
WALNUT CREEK CA
94598-3078
US

V. Phone/Fax

Practice location:
  • Phone: 925-938-1991
  • Fax:
Mailing address:
  • Phone: 925-938-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberG24111
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN R. ROSTKOWSKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 925-938-1991