Provider Demographics
NPI:1962042267
Name:FIATOA, ROXANNE MELAINE (EMT)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:MELAINE
Last Name:FIATOA
Suffix:
Gender:F
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W F ST
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-5963
Mailing Address - Country:US
Mailing Address - Phone:209-668-5972
Mailing Address - Fax:209-656-5636
Practice Address - Street 1:500 W F ST
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-5963
Practice Address - Country:US
Practice Address - Phone:209-668-5972
Practice Address - Fax:209-656-5636
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE120396146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic