Provider Demographics
NPI:1386373660
Name:ROJAS NODA, IVYANETTE
Entity type:Individual
Prefix:
First Name:IVYANETTE
Middle Name:
Last Name:ROJAS NODA
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 1:24847 SW 113TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7191
Mailing Address - Country:US
Mailing Address - Phone:786-484-8164
Mailing Address - Fax:
Practice Address - Street 1:24847 SW 113TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7191
Practice Address - Country:US
Practice Address - Phone:786-484-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-217752106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician