Fogg, Mitzi Carolina

Fogg, Mitzi Carolina is an individual health care provider with primary practice located at 1801 E Cotati Ave , Rohnert Park CA 94928-3609. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Fogg, Mitzi Carolina can be contacted via phone (707) 664-2921.

Contact Information

Primary practice address
1801 E Cotati Ave Rohnert Park CA 94928-3609
Phone: (707) 664-2921
Fax: (707) 664-2925
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 633049 California

Profile Details

NPI number 1881802148
LBN Legal business name Fogg, Mitzi Carolina
Credentials R.N., M.S.N., F.N.P.
Entity Individual
Sole proprietor 1 No
Enumeration date May 18th, 2007
Last updated Oct 25th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881802148 NPPES
California MEDICAID 1881802148

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