Healthcare Provider Details

I. General information

NPI: 1184782476
Provider Name (Legal Business Name): JOHN J ROZA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 DOUGLAS BLVD
ROSEVILLE CA
95678-2711
US

IV. Provider business mailing address

800 DOUGLAS BLVD
ROSEVILLE CA
95678-2711
US

V. Phone/Fax

Practice location:
  • Phone: 916-786-2267
  • Fax: 916-786-9335
Mailing address:
  • Phone: 916-786-2267
  • Fax: 916-786-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberDC019023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: