Healthcare Provider Details

I. General information

NPI: 1225771132
Provider Name (Legal Business Name): MS. ROSHON MALONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6127 FAIR OAKS BLVD
CARMICHAEL CA
95608-4818
US

IV. Provider business mailing address

6127 FAIR OAKS BLVD
CARMICHAEL CA
95608-4818
US

V. Phone/Fax

Practice location:
  • Phone: 916-974-8090
  • Fax:
Mailing address:
  • Phone: 916-974-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number194590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: