Healthcare Provider Details

I. General information

NPI: 1962449249
Provider Name (Legal Business Name): MARY CHIEN ROZELLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATHERINE CHIEN PA-C

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1792 TRIBUTE RD STE 200
SACRAMENTO CA
95815-4320
US

IV. Provider business mailing address

1792 TRIBUTE RD STE 200
SACRAMENTO CA
95815-4320
US

V. Phone/Fax

Practice location:
  • Phone: 916-678-7270
  • Fax: 916-514-1799
Mailing address:
  • Phone: 916-678-7270
  • Fax: 916-514-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: