Provider Demographics
NPI:1073352951
Name:RIOS, ROXANA LORENA
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:LORENA
Last Name:RIOS
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 1:18608 NE 18TH AVE APT 154
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5324
Mailing Address - Country:US
Mailing Address - Phone:786-597-4657
Mailing Address - Fax:
Practice Address - Street 1:18608 NE 18TH AVE APT 154
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-5324
Practice Address - Country:US
Practice Address - Phone:786-597-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-347272106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician