Healthcare Provider Details

I. General information

NPI: 1568467066
Provider Name (Legal Business Name): RORY G OSBORNE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 OAK AVE STE A
DAVIS CA
95616-1072
US

IV. Provider business mailing address

1627 OAK AVE STE A
DAVIS CA
95616-1072
US

V. Phone/Fax

Practice location:
  • Phone: 530-756-0555
  • Fax: 530-756-1368
Mailing address:
  • Phone: 530-756-0555
  • Fax: 530-756-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: