Provider Demographics
NPI:1518221498
Name:ROJAS, GUSTAVO
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:ROJAS
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 1:4475 SW 160TH AVE
Mailing Address - Street 2:APT 103
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5735
Mailing Address - Country:US
Mailing Address - Phone:786-449-9857
Mailing Address - Fax:
Practice Address - Street 1:4475 SW 160TH AVE
Practice Address - Street 2:APT 103
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5735
Practice Address - Country:US
Practice Address - Phone:786-449-9857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37474225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist