Healthcare Provider Details

I. General information

NPI: 1881581205
Provider Name (Legal Business Name): SILVA BEDROSSIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PADRE PKWY STE 101
ROHNERT PARK CA
94928-2114
US

IV. Provider business mailing address

1524 MAYFLOWER PL
SANTA ROSA CA
95403-2347
US

V. Phone/Fax

Practice location:
  • Phone: 650-648-4170
  • Fax:
Mailing address:
  • Phone: 707-477-4635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: