Healthcare Provider Details

I. General information

NPI: 1902722283
Provider Name (Legal Business Name): T-JA ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2444 SANDERS LN
FAIRFIELD CA
94533-1568
US

IV. Provider business mailing address

5065 SOPRANO CIR
FAIRFIELD CA
94534-6897
US

V. Phone/Fax

Practice location:
  • Phone: 707-803-0654
  • Fax: 707-402-6504
Mailing address:
  • Phone: 707-803-0654
  • Fax: 707-402-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ROGIE MALLARI
Title or Position: MANAGING OWNER
Credential:
Phone: 707-803-0654