Provider Demographics
NPI:1629839196
Name:ROGERS, REZYL
Entity Type:Individual
Prefix:
First Name:REZYL
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BILLINGTON LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8744
Mailing Address - Country:US
Mailing Address - Phone:707-758-8265
Mailing Address - Fax:
Practice Address - Street 1:10 BILLINGTON LN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-8744
Practice Address - Country:US
Practice Address - Phone:707-758-8265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA726644164X00000X
CA65992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164X00000XNursing Service ProvidersLicensed Vocational Nurse