Healthcare Provider Details

I. General information

NPI: 1881836955
Provider Name (Legal Business Name): BRANDON T ROZELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

2020 H ST UNIT F
SACRAMENTO CA
95811-3128
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7560
  • Fax:
Mailing address:
  • Phone: 919-830-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: