Provider Demographics
NPI:1437794633
Name:SIXTO, ROXANA
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:SIXTO
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 1:9110 SW 148TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4120
Mailing Address - Country:US
Mailing Address - Phone:786-398-1748
Mailing Address - Fax:
Practice Address - Street 1:9110 SW 148TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4120
Practice Address - Country:US
Practice Address - Phone:786-398-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2023-12-12
Deactivation Date:2023-12-04
Deactivation Code:
Reactivation Date:2023-12-12
Provider Licenses
StateLicense IDTaxonomies
FLBCBA-1-21-57368103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst