Provider Demographics
NPI:1912793977
Name:OHKUBO, ANANDI S
Entity type:Individual
Prefix:
First Name:ANANDI
Middle Name:S
Last Name:OHKUBO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3373 MOJAVE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-4207
Mailing Address - Country:US
Mailing Address - Phone:707-800-2096
Mailing Address - Fax:
Practice Address - Street 1:1501 MEDOCINO AVENUE
Practice Address - Street 2:STUDENT HEALTH SERVICES
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401
Practice Address - Country:US
Practice Address - Phone:707-524-1513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95366693163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health