Healthcare Provider Details

I. General information

NPI: 1083859870
Provider Name (Legal Business Name): MICHAEL JAMES ROGERS LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 SOUTH ST
ANDERSON CA
96007-3439
US

IV. Provider business mailing address

2130 SOUTH ST
ANDERSON CA
96007-3439
US

V. Phone/Fax

Practice location:
  • Phone: 530-365-5815
  • Fax:
Mailing address:
  • Phone: 530-365-5815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN 218090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: