Provider Demographics
NPI:1285013243
Name:ROJAS, NICOLAS (ABOC)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:ROJAS
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 1/2 S RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6413
Mailing Address - Country:US
Mailing Address - Phone:909-421-4547
Mailing Address - Fax:
Practice Address - Street 1:109 1/2 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6413
Practice Address - Country:US
Practice Address - Phone:909-421-4547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-23
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD70612156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician