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1194803254
MARK J. PROVDA
WALNUT CREEK, CA
NPI
1194803254
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207P00000X Emergency Medicine
(Licence: CA C37075)
Enumeration Date
2006-11-02
Last Update Date
2007-07-08
Business Address
MARK J. PROVDA MD
1425 S MAIN ST
WALNUT CREEK, CA 94596-5318
Phone number: 925-295-4000
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Mailing Address
MARK J. PROVDA MD
1800 HARRISON ST FL 7
OAKLAND, CA 94612-3429
Phone number: 510-625-6262
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