Provider Demographics
NPI:1205007069
Name:ROVNO, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ROVNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2958
Mailing Address - Country:US
Mailing Address - Phone:510-531-7523
Mailing Address - Fax:
Practice Address - Street 1:2220 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2958
Practice Address - Country:US
Practice Address - Phone:510-531-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC289172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33781Medicare UPIN