Provider Demographics
NPI:1912580846
Name:MIJARES ROJAS, IVAN ALFREDO (MD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:ALFREDO
Last Name:MIJARES ROJAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CIRCUITO LA FLOR #102
Mailing Address - Street 2:FRACCIONAMIENTO HACIENDAS
Mailing Address - City:DURANGO
Mailing Address - State:DURANGO
Mailing Address - Zip Code:34217
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12 AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-5215
Practice Address - Fax:305-585-8137
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program