| Doctor Name: | GREG ROUSSETT |
| NPI Number: | 1003114372 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | 20112 |
| Business Practice Address: | 525 21st St Oakland, CA - 946121605 |
| Business Phone Number: | 5105873426 |
| Business Fax Number: | |
| Mailing Address: | 525 21st St, OAKLAND |
| State: | CA |
| Postal Code: | 946121605 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/10/2011 |
| NPI Last Update Date: | 10/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 20112 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |