Healthcare Provider Details

I. General information

NPI: 1700599362
Provider Name (Legal Business Name): MARY AMBRIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 EUREKA RD STE 102
ROSEVILLE CA
95661-2849
US

IV. Provider business mailing address

1520 EUREKA RD STE 102
ROSEVILLE CA
95661-2849
US

V. Phone/Fax

Practice location:
  • Phone: 916-759-1168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: