Provider Demographics
NPI:1316772361
Name:HODGE-WREN, ZITA (PMHNP, FNP, RN, MBA)
Entity type:Individual
Prefix:
First Name:ZITA
Middle Name:
Last Name:HODGE-WREN
Suffix:
Gender:
Credentials:PMHNP, FNP, RN, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7610
Mailing Address - Country:US
Mailing Address - Phone:510-829-6096
Mailing Address - Fax:
Practice Address - Street 1:5201 NORRIS CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5411
Practice Address - Country:US
Practice Address - Phone:925-415-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95102745163WP1700X
CA95023546363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163WP1700XNursing Service ProvidersRegistered NursePerinatalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily