Healthcare Provider Details

I. General information

NPI: 1891445193
Provider Name (Legal Business Name): ANDREW SOBCZAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

4790 CAUGHLIN PKWY # 356
RENO NV
89519-0907
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-4100
  • Fax:
Mailing address:
  • Phone: 775-258-1970
  • Fax: 775-258-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number29200
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: