Healthcare Provider Details

I. General information

NPI: 1548004948
Provider Name (Legal Business Name): OSAWARU FRANK OGUNSUYI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 SANDRINGHAM WAY
ROSEVILLE CA
95661-5321
US

IV. Provider business mailing address

1085 SANDRINGHAM WAY
ROSEVILLE CA
95661-5321
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-7800
  • Fax: 888-870-9642
Mailing address:
  • Phone: 916-642-7800
  • Fax: 888-870-9642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: