Paul Alexander Vanravenswaay, MD
Individual provider Active NPI Psychiatry Physician · Tiburon, CA
NPI 1790766566 · NPPES record last updated Feb 27, 2015
Key facts
- NPI
- 1790766566
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- G132570 (CA)
- Practice address
- 125 Solano St
Tiburon, CA 94920-1969 - Phone
- (415) 900-5022
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 132570 | CA | MD | Marriage & Family Therapist |
| G132570 | CA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Tuolumne | Current |
Accepting new patients | |
| Arundel Mental Health Professionals L.C. | Past | Accepting new patients |
Locations
105 Hospital Rd
Sonora, CA 95370
Phone (209) 533-6245
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G132570 | CA | Yes |
Addresses
Primary practice location
125 Solano St
Tiburon, CA 94920-1969
Mailing address
125 Solano St
Tiburon, CA 94920-1969
Phone (415) 900-5022
Other providers in Tiburon, CA
- Lauren Stephany
- Susan Howard Stephens
- Stan Taubman
- Tiburon Physical Therapy Center Inc
- Fatai Tokolahi
- Terry Anne Whitten
- Julie Anne Winfield
- Teresa Zhen
All providers in Tiburon, CA · Psychiatry Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.