Healthcare Provider Details

I. General information

NPI: 1447091673
Provider Name (Legal Business Name): ZAIRA MEJIA ROMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 CREEKSIDE RIDGE DR STE 208
ROSEVILLE CA
95678-3504
US

IV. Provider business mailing address

900 MARMARA AVE
BAKERSFIELD CA
93307-6095
US

V. Phone/Fax

Practice location:
  • Phone: 916-729-3098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: