Provider Demographics
NPI:1861424665
Name:ROSTKOWSKI, JOHN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:ROSTKOWSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1150 ARLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-2322
Mailing Address - Country:US
Mailing Address - Phone:925-899-3883
Mailing Address - Fax:925-229-9037
Practice Address - Street 1:1420 WILLOW PASS RD # 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5823
Practice Address - Country:US
Practice Address - Phone:925-899-3883
Practice Address - Fax:925-229-9037
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG241112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G241110Medicaid
CA00G241110Medicaid
CAA42161Medicare UPIN