Healthcare Provider Details

I. General information

NPI: 1720995160
Provider Name (Legal Business Name): JATZIRY MARIVY HERNANDEZ ROJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 ARDEN WAY STE 119
SACRAMENTO CA
95815-4027
US

IV. Provider business mailing address

2121 GLACIER DR APT 17
DAVIS CA
95616-7337
US

V. Phone/Fax

Practice location:
  • Phone: 213-259-0245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: