Provider Demographics
NPI:1457077216
Name:BERUMEN ZESATI, EMILIA
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:
Last Name:BERUMEN ZESATI
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 1:124 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2232
Mailing Address - Country:US
Mailing Address - Phone:916-774-6802
Mailing Address - Fax:916-774-2685
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2232
Practice Address - Country:US
Practice Address - Phone:916-774-6802
Practice Address - Fax:916-774-2685
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator