MEDICARE: SPECTRUM O & P OF SANTA ROSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1851760086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM O & P OF SANTA ROSA

Provider Business Mailing Address
First Line	:	3540 E BARNETT STE A
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504
Country	:	US
Telephone Number	:	541-734-2435
Fax Number	:	541-734-4366

Provider Business Practice Location Address
First Line	:	95 MONTGOMERY DR STE 102
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-6617
Country	:	US
Telephone Number	:	707-528-8858
Fax Number	:	707-528-8840

Authorized Official
Title or Position	:	CEO
Name	:	IVAN SABEL
Credential	:
Telephone Number	:	541-734-2435

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	05/19/2026

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Directions to “SPECTRUM O & P OF SANTA ROSA ” Practice Location

Language	Start Address	Practice Location

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