Provider Demographics
NPI:1568467066
Name:OSBORNE, RORY G (PHD)
Entity type:Individual
Prefix:
First Name:RORY
Middle Name:G
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 OAK AVE
Mailing Address - Street 2:STE A
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1072
Mailing Address - Country:US
Mailing Address - Phone:530-756-0555
Mailing Address - Fax:530-756-1368
Practice Address - Street 1:1627 OAK AVE
Practice Address - Street 2:STE A
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1072
Practice Address - Country:US
Practice Address - Phone:530-756-0555
Practice Address - Fax:530-756-1368
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL161440Medicare ID - Type UnspecifiedMEDICARE