MEDICARE: DR. TONY ROFFERS PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY3704	CA

General Provider Information

NPI Number	:	1639481757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONY ROFFERS PHD

Provider Business Mailing Address
First Line	:	3542 FRUITVALE AVE
Second Line	:	#218
City	:	OAKLAND
State	:	CA
Zip	:	94602-2327
Country	:	US
Telephone Number	:	510-531-6730
Fax Number	:	510-531-6730

Provider Business Practice Location Address
First Line	:	3978 FOREST HILL AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-2416
Country	:	US
Telephone Number	:	510-531-6730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	07/06/2010

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Directions to “ DR. TONY ROFFERS PHD” Practice Location

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