Healthcare Provider Details

I. General information

NPI: 1629382254
Provider Name (Legal Business Name): ROSALIE LANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9343 TECH CENTER DR
SACRAMENTO CA
95826-2563
US

IV. Provider business mailing address

9343 TECH CENTER DR
SACRAMENTO CA
95826-2563
US

V. Phone/Fax

Practice location:
  • Phone: 916-388-6400
  • Fax: 916-388-6400
Mailing address:
  • Phone: 916-388-6400
  • Fax: 916-649-7158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: