Healthcare Provider Details

I. General information

NPI: 1912793977
Provider Name (Legal Business Name): ANANDI S OHKUBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 CONCOURSE BLVD
SANTA ROSA CA
95403-8210
US

IV. Provider business mailing address

1501 MENDOCINO AVE STUDENT HEALTH SERVICES
SANTA ROSA CA
95401-4332
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-3400
  • Fax:
Mailing address:
  • Phone: 707-524-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95039154
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number95366693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: