MEDICARE: MR. VIVEK MAHAJAN

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	310400000X	Assisted Living Facility	315002894	CA

General Provider Information

NPI Number	:	1871458695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VIVEK MAHAJAN

Provider Business Mailing Address
First Line	:	1434 ELM ST
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-2072
Country	:	US
Telephone Number	:	980-309-2097
Fax Number	:	916-547-2452

Provider Business Practice Location Address
First Line	:	1434 ELM ST
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-2072
Country	:	US
Telephone Number	:	980-309-2097
Fax Number	:	916-547-2452

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

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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