MEDICARE: ZIMRA R ROZ RDHAP

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	125K00000X	Advanced Practice Dental Therapist	477	CA
2	106H00000X	Marriage & Family Therapist	160778	CA
3	124Q00000X	Dental Hygienist	25158	CA

General Provider Information

NPI Number	:	1861820888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZIMRA R ROZ RDHAP

Provider Business Mailing Address
First Line	:	7028 FIRMAMENT AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-5189
Country	:	US
Telephone Number	:	818-732-1766
Fax Number	:

Provider Business Practice Location Address
First Line	:	7028 FIRMAMENT AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-5189
Country	:	US
Telephone Number	:	818-732-1766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2013
Last Update Date	:	04/07/2026

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