Provider Demographics
NPI:1073151171
Name:ROTICH, ERICK
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:ROTICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 W ILLINI ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-1915
Mailing Address - Country:US
Mailing Address - Phone:520-339-3327
Mailing Address - Fax:
Practice Address - Street 1:6218 W RAYMOND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1918
Practice Address - Country:US
Practice Address - Phone:520-339-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician