Healthcare Provider Details

I. General information

NPI: 1568982866
Provider Name (Legal Business Name): CHRISTOPHER ROBERTSON NYLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SOTOYOME ST STE 201
SANTA ROSA CA
95405-4822
US

IV. Provider business mailing address

12 DUTCH VALLEY LN
SAN ANSELMO CA
94960-1016
US

V. Phone/Fax

Practice location:
  • Phone: 707-293-3845
  • Fax: 707-757-6722
Mailing address:
  • Phone: 510-455-7259
  • Fax: 707-757-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA170777
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA170777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: