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General NPI Number Information
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NPI Number | 1114781622
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Entity Type | Organization
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Legal Business Name | T-JA ENTERPRISE LLC
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Dates
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Enumeration Date | 02/06/2024
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 107 SANDPIPER DR
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City | VALLEJO
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State | CA
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Zip | 94589-1438
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Country | US
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Telephone | 707-803-0654
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Fax | 707-402-6504
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Provider Business Mailing Address
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Address Line | 5065 SOPRANO CIR
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City | FAIRFIELD
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State | CA
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Zip | 94534-6897
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Country | US
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Telephone | 707-803-0654
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Fax |
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | ROGIE MALLARI
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Credential | LICENSEE
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Telephone | 707-803-0654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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