Provider Demographics
NPI:1386652253
Name:SOVAK, RONALD JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:SOVAK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 N SAN MATEO DR
Mailing Address - Street 2:#2
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2543
Mailing Address - Country:US
Mailing Address - Phone:650-348-1519
Mailing Address - Fax:650-843-1549
Practice Address - Street 1:327 N SAN MATEO DR
Practice Address - Street 2:#2
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2543
Practice Address - Country:US
Practice Address - Phone:650-348-1519
Practice Address - Fax:650-843-1549
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS24001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ82708ZMedicare ID - Type Unspecified