Provider Demographics
NPI:1588951875
Name:ROJAS, ALBA YAMILLE
Entity type:Individual
Prefix:
First Name:ALBA
Middle Name:YAMILLE
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 1:9325 LAGOON PL
Mailing Address - Street 2:210
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6731
Mailing Address - Country:US
Mailing Address - Phone:954-610-7646
Mailing Address - Fax:
Practice Address - Street 1:2145 DAVIE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-3161
Practice Address - Country:US
Practice Address - Phone:954-533-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL002036700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002036700Medicaid