Healthcare Provider Details

I. General information

NPI: 1013340751
Provider Name (Legal Business Name): OASIS HEALTH AND WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7275 E. SOUTHGATE DR SUIT 408
SACRAMENTO CA
95823-2629
US

IV. Provider business mailing address

7275 E SOUTHGATE DR STE 408
SACRAMENTO CA
95823-2632
US

V. Phone/Fax

Practice location:
  • Phone: 916-479-1332
  • Fax:
Mailing address:
  • Phone: 916-706-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number17711
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number17711
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number17711
License Number StateCA

VIII. Authorized Official

Name: SANDRA IMADE ODIASE
Title or Position: VICE PRESIDENT
Credential: DNP, PMHNP, FNP-BC
Phone: 916-479-1332