Provider Demographics
NPI:1558093971
Name:FERNANDEZ MORA, ROCIO ESMERALDA
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:ESMERALDA
Last Name:FERNANDEZ MORA
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 1:20040 NW 3RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2916
Mailing Address - Country:US
Mailing Address - Phone:786-378-2640
Mailing Address - Fax:
Practice Address - Street 1:701 PROMENADE DR STE 250
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-6035
Practice Address - Country:US
Practice Address - Phone:954-399-2637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-215665106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician