Provider Demographics
NPI:1114765989
Name:ZALDIVAR ROJAS, RAIZA
Entity type:Individual
Prefix:
First Name:RAIZA
Middle Name:
Last Name:ZALDIVAR 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 1:6107 N GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5707
Mailing Address - Country:US
Mailing Address - Phone:813-753-4370
Mailing Address - Fax:
Practice Address - Street 1:6107 N GLEN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5707
Practice Address - Country:US
Practice Address - Phone:813-753-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-360688106S00000X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician