Healthcare Provider Details

I. General information

NPI: 1457048456
Provider Name (Legal Business Name): OSVALDO SANCHEZ FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MEDICAL CENTER DR
ROHNERT PARK CA
94928-2924
US

IV. Provider business mailing address

5739 KIRKHILL DR
MARYSVILLE CA
95901-8355
US

V. Phone/Fax

Practice location:
  • Phone: 530-538-1110
  • Fax:
Mailing address:
  • Phone: 530-923-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: