Provider Demographics
NPI:1104691526
Name:ROJAS, VANESSA LUCIA LARA
Entity type:Individual
Prefix:
First Name:VANESSA LUCIA
Middle Name:LARA
Last Name:ROJAS
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 1:743 BLAKE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1362
Mailing Address - Country:US
Mailing Address - Phone:951-961-1137
Mailing Address - Fax:
Practice Address - Street 1:743 BLAKE RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1362
Practice Address - Country:US
Practice Address - Phone:951-961-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician