Healthcare Provider Details

I. General information

NPI: 1780526954
Provider Name (Legal Business Name): JEREMIAH MATTHEW RONZZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 F ST
OMAHA NE
68127-1524
US

IV. Provider business mailing address

501 N 46TH ST APT 5406
OMAHA NE
68132-3285
US

V. Phone/Fax

Practice location:
  • Phone: 402-904-2612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: