=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871458695
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. VIVEK MAHAJAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2025
-----------------------------------------------------
Last Update Date | 12/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1434 ELM ST
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95678-2072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-309-2097
-----------------------------------------------------
Fax | 916-547-2452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1434 ELM ST
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95678-2072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-309-2097
-----------------------------------------------------
Fax | 916-547-2452
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 315002894
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------