1902722283 NPI number — T-JA ENTERPRISE LLC

Table of content: (NPI 1902722283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902722283 NPI number — T-JA ENTERPRISE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T-JA ENTERPRISE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902722283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5065 SOPRANO CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94534-6897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-803-0654
Provider Business Mailing Address Fax Number:
707-402-6504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2444 SANDERS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94533-1568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-803-0654
Provider Business Practice Location Address Fax Number:
707-402-6504
Provider Enumeration Date:
06/29/2026

Additional Information

Authorized Official

Authorized Official Last Name:
MALLARI
Authorized Official First Name:
ROGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING OWNER
Authorized Official Telephone Number:
707-803-0654

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 486804394 . This is a "CDSS RCFE FACILITY NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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