Provider Demographics
NPI:1508645987
Name:VIDAL ROJAS, ELYOENAI (CARE COACH)
Entity Type:Individual
Prefix:
First Name:ELYOENAI
Middle Name:
Last Name:VIDAL ROJAS
Suffix:
Gender:M
Credentials:CARE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:FL
Mailing Address - Zip Code:32059-0524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1415 TIMBERLANE RD STE 416
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1732
Practice Address - Country:US
Practice Address - Phone:850-757-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
FL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach