Healthcare Provider Details

I. General information

NPI: 1194964445
Provider Name (Legal Business Name): NINA ROSE POQUIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 NUT TREE CT
VACAVILLE CA
95687-3353
US

IV. Provider business mailing address

131 DONNER DR
VACAVILLE CA
95687-5505
US

V. Phone/Fax

Practice location:
  • Phone: 650-255-6384
  • Fax:
Mailing address:
  • Phone: 650-255-6384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13-0390
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: