Healthcare Provider Details

I. General information

NPI: 1164628590
Provider Name (Legal Business Name): JOSEPH IVAN EICHENSEHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 LOMBARDI CT
SANTA ROSA CA
95407-6798
US

IV. Provider business mailing address

751 LOMBARDI CT
SANTA ROSA CA
95407-6798
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-3600
  • Fax: 707-547-2229
Mailing address:
  • Phone: 707-303-3600
  • Fax: 707-547-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA105703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: