Healthcare Provider Details

I. General information

NPI: 1285239301
Provider Name (Legal Business Name): FATIMA ROZIBYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 FAIRWAY DR
SAN LEANDRO CA
94577-5629
US

IV. Provider business mailing address

32234 CREST LN
UNION CITY CA
94587-1807
US

V. Phone/Fax

Practice location:
  • Phone: 916-597-7166
  • Fax:
Mailing address:
  • Phone: 510-759-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: