Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC019023 | CA |
NPI | 1184782476 |
---|---|
Provider Name | John J Roza JR. |
First Address | Roseville, CA 95678-2711 |
Second Address | Roseville, CA 95678-2711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 12/08/2020 |